Medicare open enrollment is now in progress and will run through December 7, 2016. If you haven’t signed up yet, it’s time to enroll, reassess your current coverage and check your prescription plan formularies and tiers for pricing changes.
As a Medicare beneficiary, you can enroll in a Medicare Advantage plan instead of traditional Medicare. If you have traditional Medicare, you can add prescription drug coverage, which is Part D. Each year, members are given about seven weeks to sign up for new plans or make changes to existing coverage.
The focus of Medicare plans over the years has shifted from saving for health care to accessing more private plans with broader benefits. The Affordable Care Act (ACA) integrated the use of a quality star rating system, making it easier to identify plans with satisfied customers. Medicare Advantage is becoming increasingly popular. According to the Kaiser Family Foundation, 31 percent of people who qualify for original Medicare (Parts A and B) prefer to combine those benefits in a private Part C plan, also known as Medicare Advantage, that often includes prescription drug coverage.
Depending on your personal medical needs, you may be perfectly content with original Medicare or need more comprehensive coverage. The choice is yours, but you can only sign up from October 15 through December 7 outside of your initial eligibility window.
How to Find Medicare Plan Information
Where should you start during Medicare open enrollment? First, you need to know what’s available in your area. Plan descriptions are readily accessible on Medicare.gov via the Medicare Plan Finder. Don’t bother with the prescription drug page when you’re first exploring your options. The best recommendations for hospital and primary care will be different than the selection for the top prescription care. Choose the plan that has the combination more closely suited to your individual circumstances.
Once you’ve identified some plans that might work, click on the title of each one followed by the “benefits” tab to learn more about its features. Keep in mind that premiums are not the only indicator of cost. Look carefully at the copays, coinsurance and deductible amounts. The higher the deductible is, the lower the premium will be. Again, you are looking for something that works best for your budget. You have two options:
- High premium, lower out-of-pocket: Pay more up front in monthly premiums and less at the time of medical care.
- Low premium, higher out-of-pocket: Pay a lower monthly premium and more when you visit the doctor or get your prescription filled.
For the greatest deal, find out how well each plan pays for services that you use regularly. Plans with the circled letters D, H or V also include dental, hearing or vision benefits, respectively.
The Difference Between HMOs and PPOs
Insurance terms can be confusing, especially if you’re new to Medicare. Medicare Advantage plans operate like health maintenance organizations (HMOs) and preferred provider organizations (PPOs). The Kaiser Family Foundation reports that 64 percent of Medicare Advantage enrollees prefer HMO plans to PPOs.
HMOs require a primary doctor to coordinate care and give referrals to see specialists. You must use the doctors within the network to guarantee payment for services, except during an emergency. Serving local areas, they cost less but have fewer provider options. If you’re not attached to your provider, or you’re confident that she’s in your HMO network, then an HMO can be a good option for you.
PPOs let you pick your doctors, but you’ll get a price discount for using one in their network. Coverage is better when you stay within the plan’s list of participating providers. A PPO may be the best option if you have a doctor you like and trust who is not in the network. These types of plans have service networks that can cover both local areas, like counties, and regional areas, including entire states. They cost more because you have more options.
Call your doctor’s office or look for your physician’s name or practice on Medicare’s plan provider lists to see if he participates in the plan that you’ve chosen. You may need to change the plan or change your doctor to keep costs down.
The Final Determination
Once you’ve settled on a few possible plans, make a list of those plan names and individually search them using the Medicare Plan Finder. Add in your prescriptions when prompted. Creating a list beforehand will help expedite the process and save you some frustration. Note that proper spelling and dosage are critical elements for your prescriptions. You’ll need to make sure that your drug plan not only covers your medication, but also covers the amount that you need and how often you need to take it.
Compare these results against the original list, the one that doesn’t include your prescriptions, to find plan options that appear on both lists. Next, check the star rating, which will tell you how good the plan is based on factors like customer satisfaction and whether it successfully manages chronic illnesses. A rating of 3.5 or better is suggested overall.
After you’ve enrolled in a new Medicare Advantage plan, the plan will automatically notify original Medicare of the change, so you shouldn’t have to worry about gaps in coverage or an interruption in services. Remember that you can only sign up until December 7 this year, so start soon if you haven’t already.