What to Consider When Shopping for Medicare Coverage

Medicare's Annual Open Enrollment Period, millions of Medicare beneficiaries have a chance to make changes to their coverage for the upcoming year.

There are a few things you can do during this period.

You can change from one Medicare Advantage or Prescription Drug Plan to another. People currently enrolled in Original Medicare, which includes Part A and Part B, can also switch to a private Medicare Advantage plan, or they can drop their existing Medicare Advantage coverage to return to Original Medicare.

Making sense of Medicare, which is the federal health insurance program, may not be easy for those who qualify if they don’t know where to find information. "It's like root canal every year having to get yourself up to speed on what's covered by your plan and what's not," admits Bob Hurley, president of eHealthMedicare.com. But by focusing on a few key areas and knowing where to turn for help if you need it, you can identify a plan that will work for you.

Here are six things to consider when shopping for your Medicare coverage options.

1. Take the time to shop and compare.

Although experts encourage people to shop around and weigh their options each year during the Medicare Fall Open Enrollment Period, Medicare beneficiaries have a tendency to stick with their existing coverage and avoid making changes. A 2013 study by the Kaiser Family Foundation, for example, found that only about 13 percent of people with a Medicare Part D plan change their plan each year. That can be a costly mistake, experts say.

In fact, a 2017 survey of 30,000 people using eHealthMedicare.com found that only 10 were enrolled in the Medicare prescription drug coverage plan that covered their prescription drugs at the lowest possible price, and that by switching plans they could have saved an average of $541 over the following year.

2. Look beyond monthly premiums.

The monthly premium of a Medicare Advantage or Medicare Prescription Drug plan varies widely both across the country and within a particular market. In 2018, however, the average premium for a Part D drug plan nationwide is $35.02.

In 2018, Medicare Advantage plans have an average price of $30 per month – a decline of 6 percent from 2017. And many people have access to a Medicare Advantage plan that comes with no premium at all. Keep in mind, however, that you have to continue to pay your Part B premium.

And beware: Low monthly premiums can mask higher out-of-pocket costs. "Plans can increase the cost-sharing," says Tatiana Fassieux, chair of the board at California Health Advocates, a Medicare advocacy organization. And they will. For example, according to the health care consulting firm Avalere Health, fewer Medicare beneficiaries will have access to a Medicare Advantage plan with an out-of-pocket limit below $4,000.

A plan with a low monthly premium may end up being pricier in the long run. You need to pay close attention to a plan's copays, coinsurance and deductibles to get a sense of what your total spending could be for the year.

3. Check for your medications.

Fassieux cautions people about commonly used "preferred pharmacy networks." You'll pay less for your medications at a preferred pharmacy than you will even at those that participate with your plan but don't have this special designation, she says.

4. Confirm your doctor's affiliation.

Provider networks change all the time, so you can't count on your doctor participating with your plan the following year even if he or she did any other given year. Be sure to confirm that your doctor is still in your plan because seeing a nonparticipating physician will leave you on the hook for higher out-of-pocket costs.

"Plans are required to give beneficiaries 30 days notice if their doctor's contract is terminated," Fassieux says. In addition, she says, insurers must help you find a new physician who does participate.

5. Reach for the stars.

Medicare has a quality rating system, known as Five Star Rating, in which Medicare Advantage and Medicare Part D plans are given anywhere from one to five stars to indicate quality. Five stars are the most a plan can receive, and one is the least.

"The star ratings are underrated and underused, but I think they're really important," Hurley says. "I personally wouldn't enroll in a plan with three stars or less."

6. Get help with your decision.

Consumers should know about assistance available online, by telephone and in person to help them wade through the details.

Informational Source