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Comprehensive Guide to Medicare Advantage Plans in Virginia

Medicare Advantage Plans are an alternative to Original Medicare (Parts A and B). They offer a wide array of benefits, including prescription drug coverage. Many plans also offer extra benefits, such as hearing exams and eyeglasses. However, you need to know what to look for before enrolling in a Medicare Advantage Plan.

To help you decide which plan is right for you, the Centers for Medicare & Medicaid Services (CMS) publishes a quality rating system for each plan offering Medicare Advantage and Part D. The CMS star ratings are based on information about the plan’s performance in managing chronic conditions, how easy it is to contact a member service representative, and more. You can use the star ratings to find a plan with the highest level of quality and the best overall value.

The average Medicare Advantage plan has a quality rating of 4.15 stars, up from 3.9 stars in 2022. The average quality rating is based on the overall experience of the Medicare Advantage plan with its provider network, including how easy it is to get a referral to see a specialist. Most Medicare Advantage plans have a network that includes physicians and hospitals who agree to work with the Medicare Advantage plan to provide services to its members.

Generally, Medicare Advantage plans are paid a sum of money up front to manage patient care, giving them incentives to keep patients healthy and out of the hospital. If the plan can keep costs down, they may come in under budget and make money; however, if patients stay in the hospital frequently, the plan is likely to lose money.

Many Medicare Advantage plans require that you visit in-network providers to receive full plan benefits. In addition, some Medicare Advantage plans require prior authorization for certain services. This means you must obtain permission from the plan before receiving the treatment, and in some cases the provider must send a medical record to the Medicare Advantage Plan.

Most Medicare Advantage Plans have an annual limit on how much you have to pay for out-of-pocket health costs. This cap is known as the Out-of-Pocket Maximum (OOP). It’s important to have an OOP maximum to help you avoid unexpected health care bills.

In addition, many Medicare Advantage Plans have additional benefits such as meals, transportation, and fitness activities. Some plans charge a premium for these services, while others do not. In 2022, more than 7 in 10 Medicare Advantage Plan enrollees were enrolled in a plan that did not charge a premium other than the Medicare Part B premium.

In 2023, the number of Medicare Advantage plans available nationwide increased by 8 percent from 2021. This is the largest increase in available Medicare Advantage plans in more than a decade. This expansion in options is largely driven by private insurance companies and employers that offer Medicare Advantage plans to their employees. Some religious or fraternal organizations also offer Medicare Advantage plans and restrict enrollment to members of their organization.

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