Best Medicare Advantage plan for seeing doctors outside a network in Somerset County, Maryland

Why this plan

Johns Hopkins Advantage MD Access (PPO) is a PPO, so it pays for covered care from doctors in and out of its network. Its premiums, $564 a year, plus its $11,300 limit on care in and out of network together come to $11,864 at most: the lowest worst case of the 5 PPOs here. The next is Johns Hopkins Advantage MD (PPO), at $12,440 a year at most ($1,140 in premiums plus a $11,300 limit).

For care in its network alone, the limit is $8,000.

CareFirst BlueCross BlueShield Advantage Complete (PPO) would come first on this alone, but Medicare rates it 2.5 stars, below the 3 stars we require for a pick.

What it gives up

• Its premium, $47 a month, is higher than most plans here; the middle plan charges $41 a month.
• Its out-of-pocket limit, $8,000, is higher than most here (the middle plan's is $7,975): in a year with a lot of care, it could cost you more than other plans.

Who it suits

A PPO suits you if a doctor you want to keep isn't in a plan's network, or you spend part of the year in another state. You pay more out of network, and a doctor outside it can decline to bill the plan, but the plan still pays its share. An HMO usually pays nothing outside its network except in an emergency.

The next best for seeing doctors outside a network

Before you choose

• Check your doctors and hospitals. Most Medicare Advantage plans pay only, or mostly, for care in their own network. Ask the plan, or your doctor's office, before you join.
• Price your prescriptions. What your drugs cost can differ by hundreds of dollars a year between plans and outweigh any premium difference. Add them in our plan list to see your own costs.
• Read the plan's own documents. We take every figure from what the plan filed with Medicare, but its Evidence of Coverage is the final word on what it pays.
• Get free advice if you want it. Your State Health Insurance Assistance Program (SHIP) gives free, unbiased help choosing a plan.

How we picked

Among PPO plans, which pay for covered care from doctors outside their network, the one whose worst year costs least: twelve months of premiums plus its yearly limit on what you pay for in- and out-of-network care together. Where several tie, we look next at the highest star rating, then the largest Part B giveback, then the lowest premium, then the lowest out-of-pocket limit for in-network care, then the lowest copay to see a primary care doctor. Plans that still tie are listed by name.

We compare the 11 Medicare Advantage plans with drug coverage that anyone with Medicare in Somerset County can join. Special needs plans and PACE, which are only for people who qualify, aren't included; you'll find them on the Somerset County page. No plan pays to be picked.

We don't pick plans Medicare rates below 3 stars, and leave 3 out here: CareFirst BlueCross BlueShield Advantage Complete (PPO) (2.5 stars), CareFirst BlueCross BlueShield Advantage Essential (PPO) (2.5 stars), CareFirst BlueCross BlueShield Advantage Signature (PPO) (2.5 stars). Plans too new to have a rating are included, and say so.