MEDICARE PART C
FINDING A MEDICARE ADVANTAGE PLAN
PART A IS YOUR HOSPITAL COVERAGE. IT PAYS THE COSTS ASSOCIATED WITH HOSPITALIZATION.
PART B IS YOUR MEDICAL COVERAGE. IT PAYS WHEN YOU SEE YOUR DOCTORS. IT ALSO PAYS FOR YOUR LAB WORK, X-RAYS, ETC.
PART C IS COMMONLY CALLED MEDICARE ADVANTAGE, IS PRIVATE HEALTH INSURANCE THAT REPLACES PARTS A AND B. IT'S A CHOICE, NOT AUTOMATIC.
PART D COVERS YOUR PRESCRIPTIONS. LIKE PART C, IT'S AN OPTION, NOT MANDATORY OR AUTOMATIC.
To help you make the best choices possible, here are 6 easy tips that will make finding the best Medicare Advantage plan easier.
Tip 1: Compare and Research Annually
The single biggest mistake we see every year is seniors staying with the plan(s) they enrolled in the previous year, or several years ago. This can be a very costly mistake.
Plans change from year to year. With each new plan year carriers are allowed to change monthly premiums, the formulary (drug list), deductibles and more. Plus, the plan's quality rating changes, which we'll get to next.
In short, if you don't compare your current plan's premiums, deductibles and coverage with its competitors, you could be leaving a lot of money on the table. This is particularly true if you enrolled in a brand new plan. New plans are notorious for raising premiums and switching around their formularies after getting seniors to enroll.
Tip 2: Look at the Quality Ratings
Each year the Centers for Medicare and Medicaid Services (CMS) publishes a summary 5-star rating on each plan's previous year's performance. Most people never look past the summary rating, but we feel it's important to do so.
The summary rating is based on a number of important factors that will give you a pretty good idea what you can expect from a particular plan.
CMS rates how the plan manages:
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug plans are similar. CMS evaluates:
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing
By the way, plans that receive an overall rating of four to five stars get extra money from the government to spend on the healthcare of the plan's members. HINT: that means better healthcare for you if you join one of these plans.
Tip 3: Know Your Prescriptions
We don't need to tell you that the cost of medications is going up. Changes in the healthcare laws made some small improvements, yet what we pay out of pocket every year seems to out pace cost of living increases by a large margin.
There are a number of factors that will change what you pay at the pharmacy. Your prescription dosage, prior authorization restrictions, step-up therapy requirements, co-payments, co-insurance, the pharmacy you use, and a myriad of other factors mix together to change what you pay for your prescriptions versus what your neighbor pays. This is why knowing everything about your prescriptions before attempting to choose a Medicare Advantage plan is critical.
The fact is this. Your unique combination of drugs, dosages, pharmacies, and more will change what you pay. As a result, finding the best Medicare Advantage Plan for you could save you hundreds, even thousands, of dollars.
Tip 4: Be Willing to Switch Pharmacies
The drug store down the street might be more convenient, but the drug store on the other side of town or your local grocery store could save you a wad of cash. The reason for this is simple: plans negotiate preferred pharmacy contracts, and they change over time. As a result, not only do you need to shop the plan with the best prices on the drugs you take, you also need to shop the lowest price by pharmacy.
The bottom line is that you may need to use a different pharmacy to get the best price.
Tip 5: Call Your Doctor's Office
Your doctor's office knows what plans they accept, including the plans they are dropping and adding in the new year. So, give them a call and ask to speak with the billing department. This will help you narrow plans to those your favorite doctor accepts. Otherwise, you could be looking at finding a new doctor.
Tip 6: Look at the Cost of Seeing Your Doctor
So far we've put emphasis on your medications. For most seniors, this is what appears to have the most impact. However, seeing your doctor or making an emergency room visit could take a bite out of your budget if you choose the wrong health plan.
This is why we publish what each plan charges for basic inpatient and outpatient services. In general, we feel that a co-payment (fixed amount) is better than a co-insurance (percentage of cost). With a co-payment, you will always know exactly what you owe when you see your doctor or visit the emergency room. With a co-insurance, you could be looking at a bill for up to 20% of the actual cost. You should do your own research, contact a local Medicare certified insurance agent and they can help you determine which Medicare Advantage Plan will work best for you and your spouse.