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Is Medicare Advantage Plan the Same in Every State?

October 19, 20237 min read

Medicare Advantage, also known as Medicare Part C, refers to Medicare health plans offered by private insurers that provide all Original Medicare Part A and Part B benefits along with additional coverage perks. Many seniors opt for Medicare Advantage for the extra benefits and lower costs. However, Medicare Advantage Plans are not standardized across the country and can vary significantly depending on where you live.

How Medicare Advantage Plans Differ by State

While Medicare Advantage Plans must cover the same basic benefits nationwide, there are a number of differences you’ll find from one state to the next:

Number of plans available

The number of Medicare Advantage Plans available ranges widely by location. States with larger populations like California, Florida, and New York have dozens of options to choose from. More rural states may only have a handful of Medicare Advantage insurers offering coverage.

Having more plans compete for your business drives innovation and cost savings. Areas with only one or two Medicare Advantage carriers tend to end up with pricier, less robust plan choices.

Types of plans offered

The types of Medicare Advantage Plans available in each state also vary. In some areas, mostly HMOs are offered which require using in-network providers only. Other states have abundant PPOs with out-of-network coverage for greater flexibility. Plan types impact costs and provider choice.

Monthly Premiums

Average Medicare Advantage premiums fluctuate by state. California’s average premium in 2023 is $19 per month while counterparts in Florida pay $14. Rates are driven by local healthcare costs, competition, plan profitability and state regulations.

Extra benefits

Coverage extras beyond medical care like dental, vision and hearing coverage are not standardized. One state may have more Medicare Advantage Plans offer or that include dental while another focuses more on fitness memberships. Check what value-added benefits are commonly available in your location.

Healthcare costs

Out-of-pocket spending under Medicare Advantage follows federal limits but overall costs for things like hospital stays and specialist visits are traceable to local healthcare expenses which vary significantly. Average costs in Miami differ greatly from Phoenix for example.

Provider networks

Medicare Advantage Plan provider networks are designed around local populations and healthcare systems. The doctors and hospitals participating can be quite different even between neighboring states and counties based on what plans could negotiate.

Why Medicare Advantage Enrollment Differs by State

In addition to plan variability, Medicare Advantage enrollment percentages fluctuate widely by state. Nationally, 48% of Medicare beneficiaries were enrolled in Medicare Advantage Plans in 2022, up from 42% in 2020. But some states have 25% enrollment while others approach 60%.

Reasons for differences in Medicare Advantage popularity include:

·        Original Medicare costs - States where Part B premiums and out-of-pocket responsibility is higher see more Advantage sign-ups for lower costs.

·        Number of plan options - More choices and competition between insurers sparks higher Advantage enrollment as consumers find appealing deals.

·        Plan innovation - States where insurers rapidly adopt extra benefits beyond medical see faster Advantage growth.

·        Insurer competition - Areas with only one or two Medicare Advantage carriers limit growth compared to places with aggressive competition compared to Medicare Supplement insurance.

·        State regulations - Strict state rules on insurers can hamper Advantage enrollment while lax oversight boosts attractiveness.

·        Supplemental coverage access - States limiting Medicare Supplement insurance or Medigap Plan and retiree plan options inadvertently increase demand for Advantage Plans.

Does Medicare Advantage Cover the Same Services Nationwide?

All Medicare Advantage Plans must provide the same basic benefits as traditional Medicare (Parts A and B) across the country. This includes services like:

·        Inpatient hospital care

·        Doctor visits

·        Preventive care

·        Lab tests

·        X-rays/ Imaging

·        Skilled nursing facility care

·        Outpatient surgery

·        Home health care

·        Hospice

·        Durable medical equipment

·        Emergency care

Medicare sets these standards. So a Medicare Advantage Plan cannot exclude core benefits regardless of state or region. Everything covered under Parts A and B is also provided under any Medicare Advantage Plan.

Can Medicare Advantage Plans Vary by County and City?

While core benefits don't change, Medicare Advantage details often do vary at the more local county and city level. Ways Medicare Advantage coverage differs even within a state include:

·        Available Medicare Advantage insurers and plans

·        Plan premiums and deductibles

·        Provider networks and participation

·        Specific hospitals covered

·        Supplemental benefits offered

·        Total out-of-pocket spending

·        Doctor and specialist access and wait times

·        Customer service ratings

For these reasons, it pays to compare Medicare Advantage options using your county and zip code rather than just your state. Two beneficiaries living an hour apart could have very different Medicare Advantage experiences.

Finding Medicare Advantage Plans in Your State

You can use Medicare's Plan Finder tool to find and compare Medicare Advantage Plans available where you live. Simply enter your zip code and preferences to see side-by-side details of 50 states such as:

·        Monthly premiums

·        Deductibles

·        Provider networks

·        Drug coverage

·        Supplemental benefits

·        Out-of-pocket limits

·        Quality ratings

This makes understanding state, county, and local plan differences simple. Comparing plans personalized to your location is crucial when evaluating Medicare Advantage. Rarely does one state mirror another in terms of costs, coverage, and choices. Make sure to factor in your own healthcare needs and priorities too.

While all Medicare Advantage Plans provide or cover the same basic benefits nationwide, don't assume coverage details are identical coast to coast. Weigh options carefully based on where you live specifically. Medicare Advantage Plans can vary significantly at the state, county and even zip code level.

We’re Here to Help

You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at Bourgeois Insurance a Call at (985) 803-8999. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.


What is a Medicare Advantage Plan by State?

 A Medicare Advantage Plan by State refers to the different options available in each state for individuals who want to enroll in a Medicare Advantage Plan. These Medicare Plans are offered by private insurance companies and provide an alternative way to receive your Medicare benefits.

What is a Medicare Advantage Plan?

 A Medicare Advantage Plan, also known as Medicare Part C, is a type of health insurance plan offered by private companies approved by Medicare. These plans combine Medicare Part A (hospital insurance) and Part B (medical insurance) coverage and sometimes include prescription drug coverage (Medicare Part D) as well.

What is a Prescription Drug Plan?

 A Prescription Drug Plan, also known as Medicare Part D, is a plan offered by private insurance companies that provides coverage for prescription drugs. These Part D Plans are available to individuals who are enrolled in Original Medicare (Part A and Part B) or a Medicare Advantage Plan that does not include prescription drug coverage.

What is Medicare Supplement insurance or Medigap Plan?

 Medicare Supplement, also known as Medigap, is a type of insurance plan that helps cover the "gaps" in Original Medicare coverage. These plans are offered by private insurance companies and can help pay for certain out-of-pocket costs such as deductibles, copayments, and coinsurance.

Are Medicare Advantage Plans available in every state?

 Yes, Medicare Advantage Plans are available in every state. However, the specific plans and options may vary from state to state. It is important to review the available plans in your state to find the one that best suits your needs.

When is the Open Enrollment period for Medicare?

 The Open Medicare Enrollment period for Medicare is typically from October 15th to December 7th each year according to centers for Medicare. During this time, individuals can make changes to their Medicare coverage, including enrolling in or switching Medicare Advantage Plans.

How much do Medicare Advantage Plans cost by state?

 The cost of Medicare Advantage Plans may vary by state. Factors that can impact the cost include the specific plan, coverage options, and the insurance company offering the plan. It is recommended to compare plans in your state to determine the costs associated with each plan.

What does Medicare Plan include?

Medicare coverage includes hospital insurance (Medicare Part A) which helps cover inpatient care, skilled nursing facility care, hospice care, and some home health care. It also includes medical insurance (Medicare Part B) which helps cover doctor visits, outpatient care, preventive services, and some medical supplies.

What is an Open Medicare Enrollment period?

 The Open Enrollment period is a specific time period each year when individuals can make changes to their Medicare coverage. This includes enrolling in or switching Medicare Advantage Plans, as well as making changes to Medicare Part D (prescription drug) coverage.

How do I enroll in a Medicare Advantage Plan?

 To enroll in a Medicare Advantage Plan, you can visit the official Medicare website or contact a licensed insurance agent who can help you compare plans and assist with the enrollment process.

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