5 questions to ask about Medicare Advantage plans

5 questions to ask about Medicare Advantage plans as open enrollment window starts to close

Associated Press

Time is running short for Medicare Advantage customers who still need to sort through the smorgasbord of coverage options available for next year.

The annual open enrollment period ends Dec. 7 for these privately run versions of the government's Medicare program for seniors and the disabled. This window, which opened Oct. 15, is the only chance most beneficiaries have each year to find coverage or switch plans.

Medicare Advantage plans are subsidized by the government and run by insurers, and they can put a Baskin-Robbins ice cream store to shame when it comes to variety. A customer might have 30 or more choices to consider depending on where she lives. Some plans include add-ons, such as dental coverage or a gym membership, that do not come with regular Medicare or they don't charge premiums.

Benefits experts say there are several steps you can take to pluck the right plan from all those options. Here are five questions to consider.

1. Should I review my coverage even if I don't intend to switch plans?

Yes. Even though most Medicare participants don't change their coverage every year, they should at least look at the details because coverage terms can shift.

Make sure your primary doctor and key specialists like your cardiologist still accept the plan. Check that your prescription drugs are still covered, and double check the price you'll pay for them.

Pay attention, as well, to the premium, which is the monthly cost for coverage, and plan features like the deductible. That's the annual amount a patient pays out-of-pocket before most coverage starts. Changes to those items will be laid out in annual notices customers receive from their insurers.

2. I want a new plan, but the choices seem overwhelming. How do I start wading through them?

Write down the elements that are most important to you in a health plan, says Dr. Jan Berger, chief medical officer for Silverlink Communications, a health care communications company. That can help quickly pare a long list of possibilities.

If you like your doctor or care provider, you can rule out plans that do not include them in their coverage network. If you need prescription drug coverage, eliminate the plans that don't offer it.

For those plans that cover prescriptions, compare the prices you would have to pay for your current medications.

Also look at a plan's quality rating. The Centers for Medicare and Medicaid Services uses a star system to rate plans annually. Those with one star represent poor quality, and those with five reflect performance deemed excellent. Five-star plans have a gold star icon affixed to their name in the CMS Plan Finder at www.medicare.gov .

If you pick a plan that has less than a three-star rating for at least the past three years, the government will send you a letter asking if you are certain about the choice.

"The letter will say something like, 'Really?'" Berger says. "The era of pay for performance is here when it comes to Medicare."

Once you have a finalist, ask your doctor if his office has run into any coverage delays or problems with that plan, particularly for your prescriptions.

3. Some plans say they don't charge a monthly premium. Is that too good to be true?

It can be. Other costs tied to the plan are often higher in exchange for no premium or a small monthly payment.

Check the plan's annual deductible and co-insurance, which is the percentage a patient pays for a medical service after the deductible is met. Some plans also require a separate premium for drug coverage.

CMS officials have said the average monthly premium for Medicare Advantage plans will be $32.59 next year. But actual premiums can climb close to $100 a month.

4. What happens if I don't sign up by Dec. 7?

Medicare Advantage customers generally wait until the last few weeks of open enrollment to make their decision, but waiting too long might mean they miss a chance to land the plan they want.

Call centers that help individuals pick plans often get overwhelmed close to the enrollment deadline, says Ross Blair, CEO of PlanPrescriber, a subsidiary of the online insurance broker eHealthInsurance. He noted that it's often necessary to make more than one call to get enough information to make a decision.

Many coverage shoppers who miss the Dec. 7 deadline will have to wait until next year's open enrollment period to find a Medicare Advantage plan, but there are exceptions. For instance, some people who qualify for both Medicare and Medicaid, the state and federally funded program that covers the poor and disabled, can enroll any time during the year.

You can also enroll at any time in plans with five-star ratings. But only 15 Medicare Advantage plans — 11 that come with prescription drug coverage and four without it — attained that ranking for 2013. These plans are scattered around the country in California, Minnesota and Ohio, among other states.

5. None of this sounds appealing. What can you tell me about Medicare supplement policies?

Medicare supplement, or Medigap, policies may be an option for seniors who want to drop their Medicare Advantage policies for original Medicare, which covers care like hospital stays and doctor visits with the government paying the care provider directly.

Medigap policies are sold by insurers and generally cover deductibles and other costs not covered by original Medicare. Their coverage usually doesn't extend to extras like vision or dental care offered with some Medicare Advantage plans.

Premiums for Medigap policies usually are higher than those for Medicare Advantage plans, but they can lead to lower out-of-pocket costs.

Switching from Medicare Advantage to original Medicare with Medigap coverage can be tricky, with enrollment windows varying by state. Berger recommends applying for the new coverage and making sure you have it before canceling your old policy.

View Comments