Between Oct. 15 and Dec. 7, Medicare’s annual open enrollment period, millions of Medicare beneficiaries have a chance to make changes to their coverage for the upcoming year.
There are a few things you can do during this period.
You can change from one Medicare Advantage or prescription drug plan to another. People currently enrolled in Original Medicare can also switch to a private Medicare Advantage plan, or they can drop their existing Medicare Advantage coverage to return to Original Medicare.
Making sense of Medicare, the government-run health insurance plan for people with disabilities and people age 65 and older, isn’t easy. “It’s like root canal every year having to get yourself up to speed on what’s covered by your plan and what’s not,” admits Bob Hurley, president of eHealthMedicare.com. But by focusing on a few key areas and knowing where to turn for help if you need it, you can identify a plan that will work for you.
Here are six things to consider when shopping for your Medicare coverage options.
1. Take the time to shop and compare.
Although experts encourage people to shop around and weigh their options each year during this time, Medicare beneficiaries have a tendency to stick with their existing coverage and avoid making changes. A study by the Kaiser Family Foundation, for example, found that only about 13 percent of people with a Medicare Part D plan change their plan each year. That can be a costly mistake, experts say.
In fact, a recent survey of 30,000 people using eHealthMedicare.com found that only 10 were enrolled in the Medicare prescription drug coverage plan that covered their prescription drugs at the lowest possible price, and that by switching plans they could have saved an average of $541 over the course of 2017.
[See: How to Pick a Health Insurance Plan.]
2. Look beyond monthly premiums.
The monthly price of Medicare Advantage or Part D plans varies widely both across the country and within a particular market. Next year, however, the average premium for a Part D drug plan nationwide will decline to $33.50, the first time Part D average premiums have declined since 2012.
Medicare Advantage plans will come with an average price of $30 per month — a decline of 6 percent from 2017. And many people will have access to a Medicare Advantage plan that comes with no premium at all.
But beware: Low monthly premiums can mask higher out-of-pocket costs. “Plans can increase the cost-sharing,” says Elaine Wong Eakin, executive director of California Health Advocates, a Medicare advocacy organization. And they will. For example, according to the health care consulting firm Avalere Health, fewer Medicare beneficiaries will have access to a Medicare Advantage plan with an out-of-pocket limit below $4,000.
A plan with a low monthly premium may end up being pricier in the long run. You need to pay close attention to a plan’s copays, coinsurance and deductibles to get a sense of what your total spending could be for the year.
3. Check for your medications.
Wong Eakin cautions people about commonly used “preferred pharmacy networks.” You’ll pay less for your medications at a preferred pharmacy than you will even at those that participate with your plan but don’t have this special designation.
[Read: 6 Health Care Expenses Medicare Won’t Pay For.]
4. Confirm your doctor’s affiliation.
Provider networks change all the time, so you can’t count on your doctor participating with your plan in 2018 even if he or she did this year. Be sure to confirm that your doctor is still in your plan because seeing a nonparticipating physician will leave you on the hook for higher out-of-pocket costs.
“Plans are required to give beneficiaries 30 days notice if their doctor’s contract is terminated,” Wong Eakin says. In addition, she says, insurers must help you find a new physician who does participate.
5. Reach for the stars.
Medicare has a quality rating system in which Medicare Advantage and Part D plans are given anywhere from one to five stars to indicate quality. Five stars are the most a plan can receive, and one is the least.
“The star ratings are underrated and underused, but I think they’re really important,” Hurley says. “I personally wouldn’t enroll in a plan with three stars or less.”
[See: How to Help Aging Parents Manage Medications.]
6. Get help with your decision.
Consumers should know about free assistance available online, by telephone and in person to help them wade through the details.
You can find and compare Medicare Advantage and prescription-drug plans available in your area by inputting your zip code on the Plan Finder tool at Medicare.gov. You can also compare and purchase plans at eHealthMedicare.com.
Counselors are also available, free of charge, to provide you with personalized assistance through State Health Insurance Assistance Programs. You can find your local program by visiting the Medicare.gov Medicare Helpful Contacts page or by calling 1-800-MEDICARE (1-800-633-4227).
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What to Consider When Shopping for Medicare Coverage originally appeared on usnews.com
Update 11/13/17:
