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Medicare Resource Center
by Patricia Barry, AARP Bulletin, November 16, 2009
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:
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.
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.
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.
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.
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