Question: How do I use the Medicare Plan Finder tool to compare Medicare Advantage plans? What should I look at when choosing a plan?
Answer: The Plan Finder tool at Medicare.gov is the best way to compare all of the Medicare Advantage plans in your area. These plans provide medical and drug coverage from a private insurer, and are an alternative to signing up for traditional Medicare along with a medigap and a Part D prescription-drug policy. (You still have to pay the Medicare Part B premiums, and you'll usually have a monthly premium for the Medicare Advantage plan, too.)
The Plan Finder provides personalized information about the total costs you would pay over the year for your drugs and your average out-of-pocket costs based on your general health condition. It also provides details about the plans. The tool currently has information about the 2018 plans, which can help people who are enrolling in Medicare now. Starting around October 1, it will have information about the 2019 plans, which you can sign up for during the annual open-enrollment period, which runs from October 15 to December 7, 2018.
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Start at the Plan Finder main page, where you can personalize your search by entering your Medicare number. You can also do a general search by using your zip code. Answer some questions about the type of Medicare plan you have now. (Note that the Medicare Advantage plans are called "Medicare Health Plans" in this tool.) Then click on "yes" when it asks if you would like to add your drugs.
Enter the names of your medications, dosages and frequency. Next, you'll be given the option to select local pharmacies, which is important now that many plans have preferred pharmacies that charge lower co-payments than other in-network pharmacies. The default is a list of the closest pharmacies to your zip code, but you can use the drop-down menu at the top to expand the list and show pharmacies that are farther away. You can choose up to two pharmacies at a time. Then click on "continue to plan results."
You'll then see a summary page listing the number of Part D prescription-drug plans in your area, the number of Medicare Health Plans (Medicare Advantage) with drug coverage, and the number of those without drug coverage. Most people shopping for Medicare Advantage plans will be looking for plans with drug coverage. You're given several options on the left side to refine your search, such as capping your monthly premium, but it's generally best to keep the search more general at this point. However, you may want to change the health status from the default "good" to "poor" or "excellent" to adjust the tool's estimates of your out-of-pocket costs based on your general medical needs.
Click on "Medicare Health Plans with drug coverage" to see the Medicare Advantage plans in your area. You'll see a list of the plans along with information about their coverage and costs, including the estimated annual costs for your medications (and whether either of the pharmacies you listed is a preferred pharmacy under the plan); the monthly premium; deductibles and co-payments; the maximum out-of-pocket spending limit for in-network and out-of-network care; whether the plan includes some dental, vision or hearing coverage; whether all of your drugs are in the plan's formulary (which means that the plan covers your drugs); and if there are restrictions on your drugs, such as "prior authorization," which requires your doctor to provide additional information upfront on why you need a medication, or "step therapy," which requires that you try a less-expensive drug first, if possible.
The most important information is in the fifth column—"estimated annual health and drug costs"—which adds up the premiums, deductibles and the cost of your drugs as well as an estimate of your co-payments for average medical needs based on your health status.
Customer service can make a significant difference with Medicare Advantage plans, so it's also important to look at Medicare.gov's star rating for each plan in the sixth column. The rating assesses the plans on several factors, such as health plan responsiveness and care, member complaints, appeals, drug-plan customer service and managing chronic conditions. The top rating is 5 stars, which very few plans receive, but many good plans receive 4 or 4.5 stars.
You can then choose up to three plans to compare in detail. Click on the "health & drug plan benefits" tab to see details about coverage in different categories, such as inpatient and outpatient hospital coverage, cost-sharing for doctors' visits, preventive care, emergency care and supplemental benefits (such as hearing and dental services).
Because the cost can be higher for out-of-network services, it's also important to make sure your favorite doctors and hospitals are included. You'll usually need to ask the plan directly, and several insurers have web tools that let you look up providers. Some insurers have several plans in an area with different networks, so be sure to ask about the specific plan you're interested in. In-network providers can change from year to year, so it's important to find out if your doctors will still be included – even if you've been happy with your current plan.
If you'd like personalized help with your search, contact your State Health Insurance Assistance Program (SHIP). You can find local contacts by calling Medicare at 800-633-4227 or at www.shiptacenter.org. During open enrollment, the SHIP programs often have seminars in addition to offering personalized assistance.