Whether you’ve been through the Medicare Annual Election Period before, or if this is your first time, it doesn’t have to be as daunting or confusing as you may think. Before you even begin, if you currently have a Medicare Advantage plan ask yourself if you’re happy with your current plan. If the answer is yes, then there’s nothing more you need to do.
But, if you think there might be better options or if you’re circumstances have changed, here are four key tips to make it easier to choose the right plan for yourself:
How are my doctors and my preferred hospitals covered?
It’s not just whether asking “are my doctors covered?” Rather, take a close look at whether your providers are “in-network” or not participating with the health plan. Some plans might cover your doctors as out-of-network, which means that your costs will be higher than if you go to an in-network provider. So, be sure to ask specifically if your doctors and hospitals are “in-network.” Some local providers may not want to participate with large, nationally based health plans.
How are my medications covered?
Health plans use a list of drugs, called a formulary. On the formulary, the drug is categorized on certain tiers, which means that your cost share depends on which tier the drug is on. Also, not all health plans cover the same drugs on their formularies. To avoid any surprises if you switch plans, compile a list of all of your medications and review them on-by-one with the representative you’re meeting with.
That last line about meeting with a representative brings me to the next key consideration:
Is the Customer Servicing team local, and is face-to-face assistance available?
Although 21st technology all but demands that most transactions and questions are handled online or over the phone, there is still a need for face-to-face, in-person visits sometimes. Make sure that the health plan you’re using or switching to offers local in-person assistance.
Besides in-person assistance, third-party reviews and assessments are also indicators of how your experience as a health plan member is going to be. For example, The Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees all Medicare plans, assesses plans using a “5-Star Rating.”
The Medicare Star Ratings program measures Medicare beneficiaries’ experience with their health plans and the health care system. The key components that plans are measured on each year include things such as customer service, member experience, patient safety, accurate drug pricing, and the plan’s experience in managing long-term health conditions. The popular US News & World Report ranking is another key consideration.
Finally, what extra benefits or services are included above and beyond medical and pharmacy coverage?
Premiums and copays are certainly a consideration, but it’s also nice to have a little extra value in what you’re paying for in terms of premiums. Some plans include gym memberships, dental and vision coverage and more. For example, Independent Health offers a neat mobile health application called Brook, which provides support to people with diabetes or high blood pressure – including online chats with a health coach.
Of course, there are other considerations but these four tips should streamline your decision process. If you’re still unsure where to even begin and whether a Medicare Advantage plan is even right for you, check out this free guide by Independent Health: The RedShirt’s Guide to Medicare, or read this article for a high level recap of the guide.
Want to talk to a RedShirt?
Visit a RedShirt at one of our Medicare Information Centers or other locations. Visit the list of locations here.
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