This is open enrollment season, running from October 15 to December 7, when you have a chance to choose a Medicare Advantage Plan, the type of coverage selected by about 28% of the 50 million people enrolled in Medicare.
During open enrollment, you can transfer from Original Medicare to a Medicare Advantage plan, or you can swap your membership from one Medicare Advantage plan to another. Medicare Advantage plans have extra benefits such as prescription drugs, eye care and dental care, that are not covered by original Medicare. In return for these extra benefits, people who enroll in a Medicare Advantage plan, receive their care though networks of doctors and hospitals chosen by the plan.
Here are 7 vital things you need to know:
1-Follow the doctors. If you have primary care doctors or specialists you have been using, and want to keep using, make sure they will continue to be in the network of the Medicare Advantage plan where you are enrolled. The networks, which are the lists of approved doctors and hospitals by the Medicare Advantage plan, change frequently. Many insurance companies are deciding to narrow their networks for 2014. Ask your doctors now if they have signed up to continue in the plan for 2014. If the doctors have dropped out, you could face a big financial risk. If you go outside the network of your particular plan, you may be required to pay a much larger share of the cost, and in some, cases you may have to pay the full cost without any reimbursement from the insurer.
The Medicare Rights Center says you should ask these questions when you select a plan
“Will I be able to use my doctors? Are they in the plan’s network?
Do doctors and providers I want to see in the future take new patients who have this plan?
If providers aren’t in the network, will the health plan still cover my visits if I choose to see them?
Do my doctors recommend joining this plan?
Which specialists, hospitals, home health agencies and skilled nursing facilities are in the plan’s network?
Who can I choose as my Primary Care Physician (PCP)?
Does my doctor need to get approval from the plan to admit me to a hospital?
Do I need a referral from my PCP to see a specialist?”
2-If you have developed a serious illness or chronic condition, it may be better to quit your Medicare Advantage plan and return to original Medicare. Under original Medicare, you have coverage for any doctor or hospital participating in the Medicare program. This means you can see any primary care doctor, any specialist, and receive treatment at any medical center specializing in your ailment or condition. You will pay more under original Medicare, for Part B doctor coverage, Part D drug coverage, and Medi-gap supplemental coverage for your co-payments and deductible charges, than you have been paying for the Medicare Advantage plan. But you now have access to a bigger array of doctors and hospitals, an important tool in dealing with your new and challenging medical condition.
3-Check your drugs for coverage under the plan. The list of approved drugs by Medicare Advantage plans, called a formulary, is constantly changing. Plans add and remove drugs, and change the co-payments and deductibles for these medications.
Go to the government’s official Medicare website.
When you search for a health plan at this site, be sure to enter all your medications. Click on “Find health & drug plans.” You can enter up to 25 drugs, and the plan finder will show you all the plans in your zip code including the charges for medications. The system will give you a password you can retain and use later if you need to modify your drug list.
4-Check the preferred pharmacy list to make sure there is a drug store conveniently close to you. The drug prices depend on buying the medications at a pharmacy which has a contract with the health plan. Many plans are now using lists of preferred pharmacies, where the price will be cheapest. It can make a substantial difference, so you want to use a preferred pharmacy whenever possible. Make sure the plan has one located conveniently near you.
5-Check the “snowbird” coverage. Many people on Medicare travel during the year on vacation, or to visit family members. Some are “snow birds,” spending months at a time in Florida to avoid the cold weather in the northeast. If you are among them, be sure your plan has coverage in the area where you will be vacationing, or spending long periods of time. If you get sick and need lots of expensive treatment while away from your home base, you don’t want to run up huge bills to be paid out of your own pocket.
6-When using the plan finder at Medicare.gov, check the plan’s total cost, not just the premium. Some people are dazzled by the idea of a plan that seems to be free because it has a very small or even a zero monthly premium. Don’t get fooled by this. Look at the column “Estimated annual health and drug costs,” to see what a plan is likely to cost you. And look at the “Health Benefits” column, which shows the out-of-pocket spending limits for the year when you stay within the plan network, and the limits when you go outside the network to get care. Some plans may have no limits for out-of-network spending, which could drive up your spending if you develop a sudden health problem and need to see lots of specialists.
7-Look at the stars. The federal government gives plans ratings between one and five stars. Only a small number of plans get the top 5-star ratings. Although Open Enrollment ends on December 7, you can still change to a five-star plan between December 8 and next November 30.
The 5-star plans are called “excellent” by the federal government, and the four-star plans are designated “above average.”
Only 3% of all Medicare Advantage plans get the 5-star rating, while 35% are ranked at 4-stars or 4.5 stars, according to HealthPocket, which offers comparisons and rankings on a wide variety of health insurance plans, including Medicare, Medicaid, and private coverage for individuals and small business.