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
- Go to the Medicare website at www.medicare.gov.
- Click on “Compare Health Plans.”
- Click on “Find and Compare Health Plans.”
- Click on “Begin General Plan Search.”
- Enter your ZIP code. Ignore “Age Range” and “Health Status.” Answer the questions that follow. Click “Continue.”
- 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.”
- Read the page about your current coverage and future options if you wish. Click “Continue.”
- 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.)
- 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.)
- 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.
Things to consider when comparing plans
As useful as this information is, you should be aware that comparing MA plans is not an apples-to-apples process. For example, some plans charge fixed dollar copays for visits to a doctor, while others charge a percentage of the cost. All plans make cost trade-offs—so a plan that charges no premium may charge higher copays for some services than a plan that does have a premium. Pay careful attention to hospital charges, which vary greatly among different plans. If you wish to continue your care with the doctors and hospitals you have now, make sure those providers will accept coverage from a plan that interests you—before you enroll in it.
Comparing prescription drug coverage
When looking at the details of an MA plan that provides drug coverage (not all do), you’ll see a long list of its copays according to different categories of medications. However, this information cannot tell you what you’ll pay for the specific drugs you take over the course of the year. For this you need to make a separate search.
When you’ve identified the two or three MA plans that might suit you best for your medical needs, use the Medicare Prescription Drug Plan Finder online to see how they stack up in covering your own drugs. Enter the names of your drugs, their doses, and how frequently you take them, and the plan finder automatically calculates what your total out-of-pocket expenses will be month by month through the year. This calculation is based not only on each plan’s copays, but also on what you’d pay at those times when you don’t have full coverage—such as if you have to meet an annual deductible or you fall into the gap in coverage known as the doughnut hole.
For detailed help in navigating the drug plan finder, go to the AARP Bulletin’s step-by-step guide.
Traditional Medicare—the always-available option
Sometimes Medicare beneficiaries—like the person who asked this question—live in rural communities where MA plan choices are largely limited to private fee-for-service plans that often charge substantial premiums. If you find your current plan is raising its costs or reducing benefits, and alternative plans are more than you can afford, you may be better off under the traditional program.
So when you’re using the health plan finder to review plans, it would be worth comparing their costs and benefits with those under traditional Medicare. The details of this program are given on the plan finder too—although there it’s called “original” Medicare.
Under traditional Medicare, you do not pay a premium (apart from the Part B premium you pay even if you’re enrolled in an MA plan) and you can go to any doctor, hospital or other provider that accepts Medicare patients. Copays are generally 20 percent of Medicare-approved amounts, and you pay a maximum of $1,100 (in 2010) for days 1 through 60 of a hospital stay. Traditional Medicare does not include coverage for outpatient prescription drugs. For this you would need to enroll in a “stand-alone” Part D drug plan and pay an additional monthly premium. Drug plans with premiums under $30 are available in all states.
Rules about enrolling
If you want to stay with your current plan for next year: You need do nothing. Your coverage will automatically continue next year.
If you decide to switch from one MA plan to another for next year: Just enroll in the new plan. This automatically cancels your coverage under the old plan at the end of the year. Your new coverage begins January 1.
If you decide to change from an MA plan to traditional Medicare for next year: You need to drop your current plan at the end of the year. Call the plan to cancel your enrollment—you’ll probably need to fill out a form. Or call the Medicare help line at 1-800-633-4227 to say you wish to transfer to traditional Medicare. From January 1, you’ll automatically be in the traditional program and should use your red, white, and blue Medicare card at doctors’ offices and other providers.
If you enroll in a stand-alone Part D drug coverage plan: You must enroll in a plan before the end of the year, with coverage beginning January 1. Enrolling in a drug plan will also automatically end coverage from your current MA plan at the end of the year.
Patricia Barry is a senior editor at the AARP Bulletin.