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A MEDICARE ADVANTAGE PLAN: IS IT MY BEST BET FOR 2019?

Written by: CSP-Admin

Open enrollment for Medicare runs through December 7, 2018 for plans starting January 1, 2019.

If you want to switch from original Medicare (Part A and B) to a Medicare Advantage plan (called Medicare C), change your current Advantage plan or just understand all your options, now’s the time to do it.

If you are not familiar with Advantage plans, they are a type of Medicare offered by private companies. The companies contract with Medicare to provide you insurance. Most Medicare Advantage plans are health maintenance organizations (HMOs) or preferred provider organizations (PPOs). However, some Medicare Advantage plans are private fee-for-service plans.

An advantage to buying a Medicare Advantage plan is that they can include pharmacy coverage, as well as other supplemental coverage like dental and vision, and you may pay less in monthly premiums than you would for supplemental plans and traditional Medicare.

Don’t ignore open enrollment

If you already have a Medicare Advantage plan, you should have received your annual notice of change from that plan. Medicare Advantage plans are required to tell you of any changes for the upcoming year prior to the open enrollment period. If you don’t make changes by December 7, 2018, you won’t be able to switch until the next open enrollment period unless you face a qualifying life event. A qualifying life event includes a spouse’s death, retirement or change of job.

Your annual notice of change will tell you of any changes in the plan’s costs, benefits, coverages or service areas and rules for the upcoming year. If you are OK with the changes, you don’t have to do anything. But if you’re dissatisfied or want to change to a different Medicare Advantage plan, open enrollment is the time. It’s also time for people with original Medicare to change to a Medicare Advantage plan and vice-versa.
Medicare advantage plans vary on who handles your claims. You can check out the plans available to you in our state and their costs by visiting The Oregon Guide to Medicare Insurance Plans. https://healthcare.oregon.gov/shiba/Documents/or-medicare-guide.pdf.

Another good resource is the US government’s plan finder tool at https://www.medicare.gov/find-a-plan/questions/home.aspx

Medicare Advantage plan financial trade-offs

According to Insurance.com, Medicare Advantage premiums have fallen over the past few years, making them more attractive. And about half of Medicare Advantage enrollees don’t pay any premiums.

The trade-off to a low premium is that you might have higher deductibles and co-insurance when you need healthcare. Also, you will pay more or may not have any coverage if you use doctors and hospitals that aren’t part of your Advantage plan’s network.

Starting in 2019, Medicare Advantage members will have more access to supplemental benefits. Nationwide, about 270 plans that provide coverage to nearly 1.5 million enrollees will have expanded benefits, including adult daycare services, in-home support services and home-based palliative care. You can learn more about supplemental benefits included in specific plans in Oregon’s 2019 Medicare guide. Some plans will offer other additional benefits, such as reduced cost sharing for people with diabetes and congestive heart failure. Not all plans will have new benefits so be sure to check.

Drug coverage likely included in a Medicare Advantage plan

Most, but not all, Medicare Advantage plans provide prescription drug coverage. If you have original Medicare, you can buy a Part D drug coverage plan separately. However, you can’t buy a Part D plan if you have a Medicare Advantage plan. Instead, look for a Medicare Advantage plan with drug coverage.

What to look for when choosing a Medicare Advantage plan

What doctors and hospitals are in the plan’s network?

Provider networks can change each year and even mid-year. If you visit particular doctors or hospitals, make sure they’re part of the plan you choose. Not all providers accept Medicare Advantage. Your long-time doctor may accept Original Medicare, but that doesn’t mean the physician accepts a specific Medicare Advantage plan. It’s best to check with your physician’s office before signing up with a plan just to make sure.

What medications am I taking?

If you’re taking prescription drugs, examine the plan’s list of covered medications carefully.

The costs of different medications can vary greatly with each plan. It may be worth your time to set up a spreadsheet with your medications and the costs under your different Medicare Advantage and Original Medicare options.

What are the plan’s maximum out-of-pocket costs?

You may want a plan that has a low out-of-pocket maximum. If you’re healthy and don’t plan to use much health care, you might want to risk a higher out-of-pocket maximum.

You also can call the plan and talk to a plan representative. (See the state guide for contact information.) If you speak with a representative to confirm that the plan you want covers all your drugs and that the doctors, hospitals and pharmacies you want to use are in its network, take notes. Keep a record of whom you spoke with and what was said.

What will my costs be in the long run?

No one can predict what healthcare you may need, but based on your claims this year you can look for the plan that has the best coverage and costs for you.

If you choose a Medicare Advantage plan and find you’re unhappy with it, you have an out. There is an annual disenrollment period from January 1st to February 14th. During this time, you can drop your Medicare Advantage plan and go back to Original Medicare. You can’t switch Medicare Advantage plans during disenrollment, but you can buy a stand-alone prescription drug plan if you drop your Advantage plan.

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