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— A dizzying array of choices awaits those searching for a Medicare Advantage plan.
The average Medicare beneficiary has about 33 Advantage plans to chose from this year.
Medicare Advantage plans are privately run versions of the government's Medicare program, which provides health insurance for the elderly and disabled. In addition to basic Medicare coverage, many provide extras such as vision, dental or hearing coverage. Insurers have developed more than 2,000 Medicare Advantage plans serving more than 11 million people, according to the Kaiser Family Foundation.
All these options come with their own sets of variables like different deductibles, premiums and co-insurance. Here are some things to consider while you sift through your choices in the final two months of the open enrollment season for these plans.
Q: What can I sign up for this time of year?
A: Until March 31, customers can switch from original Medicare to Medicare Advantage. They can also switch Medicare Advantage plans, as long as both either have or lack drug coverage. With limited exceptions, beneficiaries cannot pick up or drop drug coverage during this period. They also can change plans only once.
Q: Dozens of plans are available to me. How can I quickly pare this list?
A: Ask your doctor's office for a list of plans they accept. Most doctors accept original Medicare, but many Advantage plans involve physician networks or they provide coverage doctors won't accept. Ask someone at your doctor's office not just whether they accept a plan but also if your access to care will change under it.
For instance, your doctor may tell you he accepts the plan but they've had trouble getting it's drug benefit to cover a particular medication, says Joe Baker, president of the nonprofit Medicare Rights Center.
"The doctor has on-the-ground experience with dealing with a particular plan," he said.
If you're taking a prescription, check the coverage the plans offer for your drug.
Q: I'm considering a Medicare Advantage plan that offers no premium or a very low one. Is that too good to be true?
A: It can be. Other costs tied to the plan might be high if premiums are low. Check the plan's annual deductible and other out-of-pocket costs like co-pays. Some plans require a separate premium for drug coverage.
You should also look at the co-insurance, which is the percentage a patient pays for a medical service after the deductible is met.
Q: What other details should I consider?
A: Check hospitalization coverage. Patients can wind up with several thousand dollars in out-of-pocket costs after a stay of only a few days, depending on the plan.
Some plans also charge a separate deductible for hospital stays. Some may pick up all costs after a stay of 10 days, but most people are released from a hospital before then, notes Mary Johnson, a policy analyst with The Senior Citizens League.
Look for out-of-pocket limits too. These cap the amount a person has to pay through things like co-pays or co-insurance in a given year. Medicare beneficiaries should be able to find a plan with a $3,400 out-of-pocket limit in most parts of the country, says Medicare Rights Center spokesman Paul Precht.
Q: Who can help me make my decision?
A: The government offers a free plan comparison tool on the Web site http://www.medicare.gov. If you don't have Internet access, call 1-800-MEDICARE.
Medicare beneficiaries also can find free benefits counseling through State Health Insurance Assistance Programs. The Web site http://www.shiptalk.org provides a directory of these offices.
Q: What's the difference between Medicare Advantage and Medicare supplement policies?
A: Medicare supplement, or Medigap, policies cover deductibles, co-insurance and other costs not covered by original Medicare. Premiums for these policies, which also are sold by private insurers, are generally higher than for Medicare Advantage plans. But Medigap policies also can lead to lower out-of-pocket costs if you have a claim.
Medigap plans do not provide the extras that Medicare Advantage plans offer. Medigap policies only pay benefits for original Medicare, so you can't keep that if you enroll in a Medicare Advantage plan.
Q: Any other caveats?
Avoid making a spur-of-the-moment decision. Don't feel pressured by a sales pitch touting a limited-time offer.
"Never make a decision under pressure or on the spot," Precht said. "If you go to a seminar or you have invited an agent into your home, look at the information but don't make the decision there."
