Medicare Advantage: Important Questionsby Denise Early on Oct. 06, 2010, under Health
Medicare Advantage shopping season is upon us. Seniors have heard about major changes coming to Medicare Advantage and they are trying to figure out what to do about their Medicare Advantage plan for 2011. I have attended training with each of the Medicare Advantage plans offered in southern Arizona and, at first glance, there aren’t lots of changes to most plans….unless you are in a plan that is being discontinued or canceled.
Because I am an insurance agent I am not allowed to go into plan-specific details here because it might be construed as advertising. But I can advise people enrolled in Medicare Advantage plans to review their plan and decide if it is working for them. If not, they need to take a look at other plans to see if something else might be a better fit.
Everyone enrolled in a Medicare Advantage plan will receive an Annual Notice of Change (ANOC) by the end of October. This usually comes in the form of a 20 – 30 page document that details your plan for the coming year as well as other benefits like optional dental coverage. The important information in this document will have two columns listing 2010 benefits and how they are changing in 2011.
Some people will get a letter saying their Advantage plan is being canceled (Evercare Chronic Illness and AARP Medicare Direct private-fee-for-service). Some people will get a letter from Health Net saying their Ruby 3 plan is being rolled into Ruby 1. Amber plan enrollees should get a letter explaining the change in co-payments from $2o to 20%. All of these people will want to look at their options for other coverage.
Here is what is important when evaluating a Medicare Advantage plan:
Are your doctors in the plan’s network? Your primary care doctor might be in one plan’s network, but your cardiologist might not be. Are you willing to change doctors to get lower co-pays in another plan?
What hospitals are in the plan’s network? Is it important to you to be able to go to TMC, UMC or Northwest Hospital? Not every plan has these hospitals in their network.
Is a large network more important to you than low co-pays? If you have five doctors you don’t want to give up, you may have to pass on a plan with the lowest doctor visit and hospital co-pays.
How are your drugs covered by the plans you are considering? I have seen certain drugs that are a tier 2 on one plan and a tier 3 on another plan. This means your co-pay could be $42 or $79 for the same drug, depending on the plan you choose.
Every plan has a an annual MOOP (maximum-out-of-pocket), but $6,700 is the highest and $3,400 is the lowest. Is this important to you?
How does the plan treat “prior authorization” for diagnostic tests? Some plans rarely require prior authorizations while other plans are known to refuse to authorize tests like CT scans or MRIs.
You should decide how you would answer each of the questions above, especially the ones about doctor and hospital networks. Your answer to the network question will quickly limit (or expand) your Medicare Advantage options. Some people want and need the lowest co-pays, and this will direct them toward one or two plans. People with diabetes, COPD, or chronic heart failure might consider special needs plans that offer benefits specific to their illnesses as well as lower prices for drugs to treat their illnesses.
The Medicare Annual Election Period is November 15 to December 31, and this is when you can apply for a new Medicare Advantage plan or a stand-alone Part D plan. Once you have selected a plan for 2011, you will not be able to change Advantage plans after January 1. In past years, people had one more chance to switch Advantage plans from January to March. That option is no longer available. So do your homework – or have an insurance broker do the work for you – and make an informed decision about your Medicare coverage.
FOR MORE INFORMATION CHECK OUT MEDICARE CHOICES OF ARIZONA.