The number of people enrolling in Medicare Advantage (MA) plans increases every year. In 2018, around one-third of beneficiaries – over 20 million people – chose an MA plan over Original Medicare. In this post, we describe how to compare Medicare Advantage plans to help you get the best plan at a price you can afford.
Review Your Current Plan
If you already have a Medicare Advantage plan, start by reviewing the Annual Notice of Change (ANOC) your plan sent you in September. It details any changes planned for next year and will help you compare plan options.
Whether you’re already enrolled in an MA plan or joining for the first time, consider each of the following items. It may be tempting rely solely on Medicare’s Five-Star Rating System when comparing Medicare Advantage plan options. However, even a 5-star plan isn’t right for everyone. The plan may not cover your provider, your prescriptions, or it could just cost too much.
Use the Five-Star Quality Rating System to Compare Medicare Advantage Plans
To help beneficiaries compare Medicare Advantage plans, the Centers for Medicare and Medicaid Services (CMS) created the Five-Star Quality Rating System.
As a quick recap, CMS rates Medicare Advantage plans according to five categories:
- Staying healthy initiatives (covered screenings, vaccinations, etc.)
- Managing chronic conditions
- Member feedback
- Member complaints and how the plan responded
- Customer service
CMS releases new quality ratings every October. The Medicare Plan Finder Tool includes the rating for each plan in your area. Five stars is, of course, the highest rating a plan can receive. Look for options with a rating of at least 3.5 stars.
Our post, The Medicare 5-Star Rating System, walks you through the entire process.
The Provider Network
The vast majority of MA plans have provider networks. If you don’t use a hospital or physician within the network, the plan offers little or no coverage. In other words, you may pay the entire cost out-of-pocket. When you use the Plan Finder Tool, click on a plan’s name, and scroll until you see whether your physician or local hospital is in the network. Also look for labs, pharmacies, and any other provider you rely on for healthcare.
Provider networks change pretty much every year. Before you join any MA plan, ask your doctor if he or she has signed up to the plan again for the upcoming year. If the answer is ‘no,’ you must either find a new plan or change doctors or hospitals.
Compare Medicare Advantage Plans’ Out-of-Pocket Limits
Remember, your MA plan’s cost includes more than the monthly premium. Your out-of-pocket costs also include deductibles, co-pays, and co-insurance. A large number of seniors make the mistake of choosing a plan with a very low monthly premium only to suffer from higher out-of-pocket expenses.
On the Plan Finder Tool, look for further details of the plan. Find out what it costs to stay in a hospital or a visit a doctor. Pay special attention to the plan’s annual out-of-pocket limit; this is the maximum amount you’ll spend in a year. It is crucial to pick a plan with a low limit in the event of a catastrophic medical emergency. Typically, a plan offers a lower limit when you pay a higher premium.
Check the Formulary
The formulary is the list of drugs an MA plan covers. The majority of plans offer Part D prescription drug coverage. Make sure the plan covers your existing medication because the formulary changes on a regular basis. If you choose a plan and it removes one or more of your medications from its list during the year, it must continue to provide you with your prescription drugs until the end of the year.
By their very nature, Medicare Advantage plans offer varying levels of coverage. Check the Plan Finder Tool to learn more about the extras offered by a plan. For example, if you see a ‘D’ and ‘V’ in small circles under a plan’s information section, it means it provides Dental and Vision coverage.
If coverage while traveling is important to you, you need to call the plan directly to get more information. Most MA plans only pay for emergency care when you are “away from home.” This is potentially a problem if you have two residences or pay lengthy visits to your adult children. Problems are possible in this scenario even for simple services such as lab tests. While some plans have national networks, you can’t see this information online.
When Can You Enroll in a Medicare Advantage Plan?
If you don’t qualify for a Special Enrollment Period (SEP), you can enroll in an MA plan twice a year. Medicare Annual Enrollment occurs every year from October 15 through December 7. It allows you make changes to your Medicare coverage whether you have an MA plan or not.
Medicare Advantage Open Enrollment lasts from January 1 through March 31. Anyone who currently has an MA plan may either change to a new plan or return to Original Medicare. Only people currently enrolled in a Medicare Advantage plan may participate.
For help understanding your Medicare options, call us toll-free at 855-350-8101 to speak to a licensed agent.