What are some good ways to get help choosing a Medicare Advantage or Part D plan during open enrollment this year?
Open enrollment for Medicare Advantage and Medicare Part D runs from October 15 to December 7, and there are a lot of great resources to help you choose the best plan for you in 2013.
Instead of relying on all of the mailings, calls and seminars offered by salespeople touting their companies’ plans, check out your options yourself. The best resource is Medicare’s Plan Finder, a comprehensive list of the Part D and Medicare Advantage plans (called “Medicare Health Plans”) available in your area.
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To compare the Part D prescription-drug plans, type in your zip code, and then your drugs and dosages. The Plan Finder will show the total out-of-pocket costs, including premiums, deductibles and co-payments, you’d pay over the year under each plan. You might find out that a plan with a low premium and high co-pays for your drugs actually costs more over a year’s time than a plan with a higher premium and lower co-pays for the drugs you need. The tool also shows whether a generic is available for any of your medications; whether the plan offers lower rates for using a mail-order or preferred pharmacy; and whether it imposes any restrictions, such as requiring prior authorization for certain drugs.
The Medicare.gov Plan Finder is also a great resource for finding Medicare Advantage plans in your area. These plans provide both medical and drug coverage from private insurers. The tool shows the total costs for your medications, as it does with the Part D plans, and it also lets you estimate your out-of-pocket expenses based on your health status -- poor, good or excellent. (The default status is “good” -- if you need to change it to “poor” or “excellent,” go to “change health status” in the “refine your search” column on the summary of your search results page.) You’ll see details about the plan, including premiums, deductibles and co-insurance; physician networks; out-of-pocket maximums; estimated annual health and drug costs for your medications and health status; and star quality rating (see Medicare Advantage Star Ratings Can Help You Pick a Plan for more information about these ratings). Check the box by the plans you’re interested in, click on “compare plans,” and you can delve into the details about each plan’s coverage and costs.
Helpful as it is, the Plan Finder tool can be complicated to navigate, especially for elderly people who aren’t used to working with computers. You or your parent can get free personalized assistance from the State Health Insurance Assistance Program (SHIP), which provides phone and in-person consultations that can walk you through the Plan Finder. The groups also hold community seminars with general information about your options. Find your local SHIP at ShipTalk.org or by calling 800-633-4227.
If you’re looking for a Medicare Advantage plan, start with the Plan Finder, which will provide information about the costs and coverage. Then supplement that research by checking out HealthMetrix Research’s Cost Share Report, at MedicareNewsWatch.com. This report is not as comprehensive as the Plan Finder -- it only includes about 100 cities -- but it provides valuable analysis, listing the best Advantage plans by area based on estimates of typical total costs for people in good, fair or poor health. The Senior Choice Gold Awards recognize the Advantage plans with the best value.
PlanPrescriber.com (888-312-5447) can also help you compare costs and coverage for Part D and Medicare Advantage plans. As with the HealthMetrix report, this resource is less comprehensive than the Plan Finder, but it is easier to navigate and also includes helpful information about Medigap plans and premiums, which can be difficult to find elsewhere. The phone reps can also answer questions about your options.
For extra hand-holding -- or help with the bigger-picture questions of how to get coverage in general -- consider a fee-based service. Allsup Medicare Advisor (866-521-7655) charges $75 for help with Part D and $175 for help with Medigap and Part D. The most useful of its services, which costs $395, helps you decide whether to go with traditional Medicare or Medicare Advantage and also reviews your open-enrollment options for Part D and Medicare Advantage, an analysis the Plan Finder won’t do for you. Healthcare Navigation (www.healthcarenavigation.com; 877-811-8211) is pricier--$750 or more, depending on the complexity of the situation--but it offers a comprehensive review of Medicare and retiree health care and can provide advice about your options if you continue to work past age 65 and need to make decisions about pairing employer coverage and Medicare.
For more information about Medicare Advantage and Part D open enrollment, see Sift Through Your Medicare Choices and What to Know About 2012 Medicare Open Enrollment.
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