Comparing Medicare Advantage Plans

Q. I’m horrified at how my Medicare Advantage plan will change for next year. It will no longer cover routine vision, hearing, and dental care, and instead of low copays I must pay 20 percent of the full cost. How can I find another plan that will give me a better deal?

A. Many people are shopping around for a new Medicare Advantage (MA) health plan—especially people with plans that are raising their prices, reducing benefits or, in some cases, pulling out of Medicare altogether for next year—during open enrollment from November 15 to December 31. You may find a better deal—or you may not. But you do have options, and it’s important to know how to assess them.

The most effective way of comparing the MA plans is to use the online plan finder on Medicare’s website. This tool is anonymous—you don’t identify yourself in any way except for your ZIP code. It’s objective—you can’t be swayed by a sales pitch or a slick brochure. And it provides comprehensive information that you can’t easily get anywhere else. It tells you:

• How many plans you can choose from in the area where you live.
• What type of plans they are—managed care organizations (HMOs and PPOs), private fee-for-service (PFFS) plans, special needs plans (SNPs), or Medicare savings accounts (MSAs).
• What each plan will charge next year for its fixed charges, such as monthly premiums and your share of the cost for each type of medical service it covers.
• What you will pay for the specific prescription drugs you take, over the whole year, under any plan that provides drug coverage.
• Whether you must go to doctors or hospitals in a plan’s network (typically the case for an HMO), can also go outside the network for a higher copay (PPO), or can see any provider that accepts the plan’s terms (PFFS).
• Which plans have an annual limit on out-of-pocket expenses for medical services.
• How Medicare rates each plan on quality issues—such as customer service, patient satisfaction, and how well it manages chronic health conditions—using a scale ranging from one star (poor) to five stars (excellent).
• Whether the plan covers any extra benefits that traditional Medicare doesn’t cover, such as routine vision, hearing and dental care, fitness programs, and health club memberships.
• How to enroll in the plan of your choice.

How to access this information in 10 easy steps

1. Go to the Medicare website at www.medicare.gov.
2. Click on “Compare Health Plans.”
3. Click on “Find and Compare Health Plans.”
4. Click on “Begin General Plan Search.”
5. Enter your ZIP code. Ignore “Age Range” and “Health Status.” Answer the questions that follow. Click “Continue.”
6. If your ZIP code spans more than one county, you’ll be asked to choose your county from a pull-down menu. Then click “Continue.”
7. Read the page about your current coverage and future options if you wish. Click “Continue.”
8. Click “Continue to Plan List.” (You can enter your prescription drugs in a different search later when you’ve decided which MA plans interest you.)
9. You will now see a list of every plan available to you, together with some broad information on each—its name and what kind of plan it is; its premium; whether it covers prescription drugs, vision, or dental care; what kind of doctor choice it provides; and its overall quality rating according to various measures of performance. (Don’t pay much attention to the column headed “Estimated Annual Cost for People Like You.” It’s an arbitrary amount, roughly based on age and health status, which appears regardless of whether you have entered this information about yourself.)
10. Click on the name of any of these plans to see details of its coverage and costs. If you wish, you can compare the details of up to three plans side by side by checking the boxes against the names of your chosen plans and then clicking on “Compare Health Benefits” at the top of the list.