If you need to enroll in a Medicare Advantage or prescription drug, change an existing plan, move to a new one or dis-enroll the annual Medicare Open Enrollment Period (October 15—December 7) is the time to take action.
Steve Zaleznick, Senior Medicare Adviser of PlanPrescriber, a website that provides free comparison tools and educational materials for Medicare-related insurance, says the big challenge for Medicare beneficiaries and their advisors is to make a plan selection that fits their needs and is sufficiently flexible to cover any unknowns the upcoming year might bring.
Tips for choosing a Medicare Advantage Plan
For some seniors, it makes sense to consider a Medicare Advantage Plan. The premiums are usually lower than the combined cost of having traditional Medicare, a Medicare Supplement plan (such as Medigap) and a Part D drug plan. But the key is to understand your needs and know what you are buying, Mr. Zaleznick says.
Here are 7 things to consider during your decision-making making process:
What is Medicare Advantage?
Medicare, the traditional health care benefit for seniors provided by the government, has coverage gaps and puts no cap on what a beneficiary could spend. Indeed, approximately of 20 percent of physician fees are paid by the beneficiary, according to Mr. Zaleznick. A Medicare Advantage Plan (such as an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies that have been approved by Medicare.
Medicare Advantage Plans vs. Medicare Supplement Plans
A Medicare supplement covers gaps in Medicare, but does not cover prescription drug costs. You would need to enroll in a separate Medicare drug plan to get that benefit. Medicare Supplement plans tend to provide more "first dollar" coverage when you require medical care. Because Medicare Advantage Plans often include a prescription plan, it may offer more encompassing coverage. Known as MA-PD, Medicare Advantage Plans still have deductibles and co-payments, but the maximum that a beneficiary will pay out-pocket, other than for drugs, is capped.
Look at Out-of-Pocket Expenses
Whether or not you need a Medicare Advantage Plan depends on how much out-of-pocket expense you are willing to take on. A good place to start is by analyzing how much money you've spent on health coverage not covered by Medicare over the last few years, including the amount you've spent on premiums, co-pays and deductibles.
Is Your Preferred Doctor in In-Network?
If you want to continue seeing your doctor, check beforehand that he or she is an in-network provider for the Medicare Advantage Plan you are considering.
Check Your Medications
Review your medications and see if they are covered by a particular plan, or not. Visit the Drug Cost Calculator tool on Plan Prescriber's website to check the medications you take.
Consult Local Experts
Rates and benefits differ widely among plans and states. Talk to someone who knows the regulations and nuances in your area.
Check Your Plan Yearly
Coverage rules and plan options change regularly and the plan you have this year may not be the optimal one for you next year as well. During the Annual Enrollment Period, revisit your choices from last year and consider other plans that might better fit your needs.
"An increasing number of Baby Boomers are now enrolling in Medicare for the first time. As they begin to understand the different types of Medicare coverage available, and the specific Medicare enrollment periods that correspond to each coverage type, the enrollment dates become even more important," Mr. Zaleznick says. "Procrastination is not your friend. Doing nothing is not the answer."