How Medicare Options Can Vary by Geography

How Medicare Options Can Vary by Geography

MSA Zip Codes

Author: Tej Seelamsetty

06-15-2021

Medicare Advantage and Medigap plans can look vastly different at the local level

Did you know that the price of Medicare Supplement (Medigap) and Medicare Advantage (MA) plans vary by state, and more specifically, zip code? Even for the same amount of coverage! For a primer on the basics of Medigap and MA plans, please check out our article here. For today, we will be discussing their differences when it comes to geography.

For folks who are new to Medicare, note that Plan G has the most coverage of any Medigap plan. Remember, Medigap plans are standardized by CMS. Thus, if you are looking for the best coverage at the lowest price, the cheapest (non-high deductible) Plan G available in your area is the benchmark you should compare all MA plans against.

MA plans, however, can be a bit more difficult to evaluate since they are not necessarily standardized. Comparing MA plans to Medigap plans can sort of be like comparing apples and oranges, especially when looking at MA HMOs (which require approval of your primary care doctor to see most specialists). In general, the best MA plans to compare with Plan G are MA PPOs with no / a low premium, a low out-of-pocket maximum (the most money you can be on the hook for in a given year), and low fixed coinsurance for visits (vs. a variable coinsurance of, say, 20% of the bill). This, of course, simplifies much of the nuance between the two buckets of Medicare plans, so if you’re trying to find the plan that’s right for you, be sure to speak with one of our licensed agents.

It’s helpful to compare Plan G pricing and MA plans offered within Metropolitan Statistical Areas (MSA -- AKA a major city and its surrounding suburbs), since options are fairly consistent within an MSA. To see how Plan G and the stronger MA PPOs compare within each of the top 10 MSAs in the US by population, we compared their core features below. The averages are taken across generally optimal Plan G and MA PPO plans for someone turning 65 in 5 random zip codes of the MSA. Note, all of the MA PPOs include drug plans and none of the MA PPOs shown require a variable coinsurance for in-network visits. Their fixed coinsurance for primary care visits range from $0-$10, and $0-$50 for specialists. See this post's thumbnail above for the zip codes selected within each MSA.

MSA 1 | New York City-Newark-Jersey City, NY-NJ-PA:

  • Average Plan G price: $206.73

  • Average of MA PPO relevant metrics:

    • Premium: $0

    • Deductible: $50

    • In-network Out-of-Pocket maximum: $6,830

Conclusion: Top PPOs in this MSA are up there with Plan G as some of the highest-coverage options available

MSA 2 | Los Angeles-Long Beach-Anaheim, CA:

  • Average Plan G price: $113.94

  • Average of MA PPO relevant metrics:

    • Premium: $89

    • Deductible: $0

    • In-network Out-of-Pocket maximum: $7,550

Conclusion: Top PPOs in this MSA likely do not provide as much value as Plan G

MSA 3 | Chicago-Naperville-Elgin, IL-IN-WI:

  • Average Plan G price: $96.16

  • Average of MA PPO relevant metrics:

    • Premium: $0

    • Deductible: $0

    • In-network Out-of-Pocket maximum: $4,260

Conclusion: Top PPOs in this MSA are up there with Plan G as some of the highest-coverage options available

MSA 4 | Dallas-Fort Worth-Arlington, TX:

  • Average Plan G price: $104.34

  • Average of MA PPO relevant metrics:

    • Premium: $0

    • Deductible: $0

    • In-network Out-of-Pocket maximum: $6,460

Conclusion: Top PPOs in this MSA are up there with Plan G as some of the highest-coverage options available, but their high Out-of-Pocket maximum should not be ignored vs. Plan G’s low premium

MSA 5 | Houston-The Woodlands-Sugar Land, TX:

  • Average Plan G price: $111.14

  • Average of MA PPO relevant metrics:

    • Premium: $0

    • Deductible: $0

    • In-network Out-of-Pocket maximum: $6,280

Conclusion: Top PPOs in this MSA are up there with Plan G as some of the highest-coverage options available, but their high Out-of-Pocket maximum should not be ignored vs. Plan G’s low premium

MSA 6 | Washington-Arlington-Alexandria, DC-VA-MD-WV:

  • Average Plan G price: $108.99

  • Average of MA PPO relevant metrics:

    • Premium: $0

    • Deductible: $188

    • In-network Out-of-Pocket maximum: $7,000

Conclusion: Top PPOs in this MSA are up there with Plan G as some of the highest-coverage options available, but their high Out-of-Pocket maximum should not be ignored vs. Plan G’s low premium

MSA 7 | Miami-Fort Lauderdale-West Palm Beach, FL:

  • Average Plan G price: $230.25

  • Average of MA PPO relevant metrics:

    • Premium: $0

    • Deductible: $0

    • In-network Out-of-Pocket maximum: $3,400

Conclusion: Top PPOs in this MSA provide best in class MA coverage vs. a relatively high-premium for Plan G

MSA 8 | Philadelphia-Camden-Wilmington, PA-NJ-DE-MD:

  • Average Plan G price: $133.03

  • Average of MA PPO relevant metrics:

    • Premium: $0

    • Deductible: $0

    • In-network Out-of-Pocket maximum: $6,500

Conclusion: Top PPOs in this MSA are up there with Plan G as some of the highest-coverage options available, but their high Out-of-Pocket maximum should not be ignored vs. Plan G’s low premium

MSA 9 | Atlanta-Sandy Springs-Alpharetta, GA:

  • Average Plan G price: $111.75

  • Average of MA PPO relevant metrics:

    • Premium: $0

    • Deductible: $0

    • In-network Out-of-Pocket maximum: $4,900

Conclusion: Top PPOs in this MSA are up there with Plan G as some of the highest-coverage options available

MSA 10 | Phoenix-Mesa-Chandler, AZ:

  • Average Plan G price: $105.98

  • Average of MA PPO relevant metrics:

    • Premium: $25

    • Deductible: $0

    • In-network Out-of-Pocket maximum: $4,000

Conclusion: Top PPOs in this MSA are up there with Plan G as some of the highest-coverage options available, but the PPOs’ premiums are not $0 in this case

MA PPOs are viable plans in many MSAs

Within these MSAs, there are quite a few Medicare Advantage PPO plans available that provide value over the benchmark Medigap Plan G. Selecting the most cost-effective Plan G available is usually a safe bet, as you can always expect top of the line coverage. However, for those who are generally healthy, having a no / low monthly premium MA PPO can save you thousands every year that you don’t need medical services outside of typical preventive care. Be sure to call one of our agents (click "call-us" at the top right corner of the page) to find out which plan is right for you.

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MSA Zip Codes
How Medicare Options Can Vary by Geography

2021-06-15

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