Medicare Advantage Matchmakingby Denise Early on Nov. 16, 2012, under Health
Helping someone pick a Medicare Advantage is kind of like matchmaking. Does a plan’s doctor network match the client’s doctor list? Does the plan’s drug coverage match the client’s prescriptions?
Seniors in Tucson are being bombarded with marketing materials from new Medicare Advantage plans as well as the plans that have been around for many years. The mailers say their plan has $0 doctor co-pays and $0 co-pays for some drugs.
The truth is that a few plans now have a $0 co-pay to see a primary care physician. But co-pays to see a specialist range from $35 to $50, depending on the plan.
The truth is that some plans now charge a $0 co-pay for some generics. But those are the cheapest generics that can be bought for $2 to $5 without any insurance. Tier 2 generics can have a co-pay of $8 to $15 depending on the plan.
Here is what to look at when picking a Medicare Advantage plan:
*Are your doctors in the plan’s network? I have heard that some doctor groups and some primary care physicians will no longer be contracted with certain Medicare Advantage plans in 2013. An insurance agent should check to make sure all your doctors will be contracted in 2013. If you are doing the research on your own, you should call your doctors’ offices and ask if they will be taking your plan in 2013- or the new plan you are considering.
For example, University Physicians is not continuing its contract with one particular Advantage plan for 2013. I have one client in that plan whose primary care doctor is with University Physicians. He has not been informed by his Advantage plan that he will not be able to see that doctor next year. Yikes!
*If you’re talking to your doctor’s office, you should also ask if they like the plan you are considering – or the plan you are currently in. Some plans require a referral for every visit to a specialist. Some plans make it difficult to get approval for tests like MRIs. And apparently, some plans don’t pay the doctors in a timely manner. All these issues can lead to doctors leaving the plan – and you could be stuck in a plan that will not allow you to see your doctor next year.
*Are your drugs all covered by the plan, and what is the co-pay? On one plan you might pay $8 for a generic. On another plan you would pay $15 for that same drug. It can get even more expensive when it comes to brand drugs. The co-pay for a “preferred brand” drug is generally $45 on most Advantage plans. But some plans will put that same drug into the “non-preferred” tier, and this will mean a $95 co-pay. This could be a deal-breaker for choosing a Medicare Advantage plan – or leaving a plan.
The key is to do your research, or have an insurance agent do it for you. Medicare Advantage plans change a little (or a lot) each year, and you could be in for a nasty surprise if you assume nothing changes from year-to-year.