How-To Compare Medicare Advantage Plans

One thing is for certain, comparing any insurance plan can be confusing and time-consuming. It is not uncommon for us to stick with the same plan year after year just out of convenience. However, sticking with a plan long-term without comparing your options can be a costly mistake.

Keep in mind; insurance plans can change from year to year. That is their right to change monthly premiums, their approved prescription drug list, deductibles, and much much more. When changes happen, it can impact not only the level of care you receive but also the amount of medical care you can afford.

Here we break it down for you on how to compare and choose the best Medicare Advantage plan to eliminate the extra time-consuming burden and demystify the process.

Reviews and Quality Ratings

First, before even thinking of comparing plans, compare the reviews and ratings. This could save you valuable time with the process of elimination. The Centers for Medicare and Medicaid Services publishes a 5-star summary rating every year on each plan’s performance of the previous year. This alone can give you a quick heads up on how or where you want to proceed in comparing Medicare Advantage plans.

The rating is based on many factors that give you an insight into what you will receive or expect from the plan. The CMS rates the health plans for how they manage:

  1. Healthy Screenings, Vaccines, Tests
  2. Chronic Long-term Conditions
  3. Member Experience and Satisfaction
  4. Changes and Complaints in Plan Performance
  5. Customer Service

And, how drug plans manage

  1. Customer service
  2. Member Experience and Satisfaction
  3. Changes in the Drug Plans
  4. Drug Accuracy and Safety

A bit of good news is plans that receive a rating of four or five stars, actually get government money to spend on healthcare. That money is passed on down to the actual members through cost-saving efforts and extra perks.

Prescription and Pharmacy Knowledge

With the changes in healthcare laws and the cost of medications consistently increasing, the small improvements that have been made are minor in comparison to our out-of-pocket expenditures. The rules of prior authorization restrictions, therapy requirements, co-insurance and co-pays, not to mention the dosage levels, all these factors come together to determine what your actual prescription cost will be.

When comparing Medicare plans, make sure to know precisely what your prescriptions are, research alternate brands, and what your pharmacy keeps in stock on a regular basis, and the charge passed on to you. Many drug plans have tiered price levels. Do due diligence in comparing before signing up with any plan.

Because of this mixture, the costs associated with your prescriptions may make you want to scramble and forgo prescription use. Research your nearby pharmacies for a price match, price difference, and keep an open mind on the possibility of switching pharmacies. Often, just making the switch could save you a substantial amount of money.

Compare your Primary Care Physician Costs

Call your primary care physician’s billing department to help you narrow down what plans may be more cost effective for your situation. Because they deal with insurance daily, they will be able to help advise you on what plans they plan on accepting, or dropping in the new year. Having this information readily available to you prior to comparing plans, will help the narrowing process.

While we are talking about your doctor, the billing department may even be able to help you compare the costs of their services based on in-patient, out-patient, and co-payments vs. co-insurance costs. One other part of the research you need to do is find out whether your doctors and hospitals are included in the plan you are comparing. Then visit the Medicare Advantage plan to research the cost breakdown and compare.

Types of Medicare Advantage Plans

There are several types of Medicare Advantage plans available to you. They are your HMO plans, PPO plans, PFFS plans, and SNP plans. If you don’t know what each abbreviation stands for, it’s Health Maintenance Organization, Preferred Provider Organization, Private Fee-for-Service, and Special Needs Plans. You’ll most likely already have one of these types of insurers. There may be other, smaller types of Medicare Advantage plans in your area other than these, so make sure to research that area as well.

You may be able to find an HMO Point of Service plan that will allow you to get out-of-network care but at a higher average cost. You can even create a Medical Savings Account, which works almost like a bank account. Medicare will deposit money into your account, and you can use it to cover any medical costs you have throughout the year.

Supplemental Benefits Comparison

It’s obvious that different types of plans will have various supplemental benefits that can add to your service. Does the plan have cost-sharing for doctor visits? Preventative care and emergency room visits? What type of inpatient and outpatient hospital coverage do you have? Is it more expensive to get treatment out of network services?

Not all of the plans work the same, so it’s incredibly important to search through all of your options. If you do not compare your plan yearly against premiums, coverage, and deductibles, you could miss out on the savings other plans provide.

Doing a bit of homework now will go a long way in ensuring you have proper coverage this year. Next year the hunt will start over.

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