Medicare’s 2018 Annual Election Period (AEP) is upon us. As with previous years, it begins on 15 October and ends on 7 December.
To help you make the best choices possible, here are seven tips that will make finding the best Medicare Advantage or Medicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plan easier.
Tip 1: Compare and Research Annually
The single biggest mistake we see every year is seniors staying with the plan(s) they enrolled in the previous year, or several years ago. This can be a very costly mistake.
Plans change from year to year. With each new plan year carriers are allowed to change monthly A premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. ..., the A formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered.... (drug list), A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share.... and more. Plus, the plan’s quality rating changes, which we’ll get to next.
In short, if you don’t compare your current plan’s 2017 premiums, deductibles and coverage with its 2017 competitors, you could be leaving a lot of money on the table. This is particularly true if you enrolled in a brand new plan. New plans are notorious for raising premiums and switching around their formularies after getting seniors to enroll.
Tip 2: Look at the Quality Ratings
Each year the The Centers for Medicare & Medicaid Services (CMS) is the U.S. Federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs.... (CMS) publishes a summary 5-star rating on each plan’s previous year’s performance. Most people never look past the summary rating, but we feel it’s important to do so.
The summary rating is based on a number of important factors that will give you a pretty good idea what you can expect from a particular plan. For health plans CMS rates how the plan manages:
- Staying Healthy: Screenings, Tests, Vaccines
- Managing Chronic (Long Term) Conditions
- Member Experience with Health Plan
- Complaints and Changes in Plans Performance
- Health Plan Customer Service
Drug plans are similar. CMS evaluates:
- Drug Plan Customer Service
- Complaints and Changes in the Drug Plan
- Member Experience with the Drug Plan
- Drug Safety and Accuracy of Drug Pricing
On MedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer.....com plan pages, we publish a breakdown of the summary ratings, in the categories listed above, so you can see how well a plan performs in the areas that are important to you.
By the way, plans that receive an overall rating of four to five stars get extra money from the government to spend on the healthcare of the plan’s members. HINT: that means better healthcare for you if you join one of these plans.
Tip 3: Know Your Prescriptions
We don’t need to tell you that the cost of medications is going up. Changes in the healthcare laws made some small improvements, yet what we pay out of pocket every year seems to out pace cost of living increases by a large margin.
There are a number of factors that will change what you pay at the pharmacy. Your prescription dosage, Prior authorization is a process used by health plans to control healthcare costs. Most HMO plans and some PPO plans require authorization before receiving certain treatments, medical services, or prescription drugs.... restrictions, step-up therapy requirements, co-payments, co-insurance, the pharmacy you use, and a myriad of other factors mix together to change what you pay for your prescriptions versus what your neighbor pays. This is why knowing everything about your prescriptions before attempting to choose a 2017 Medicare plan is critical.
The fact is this. Your unique combination of drugs, dosages, pharmacies, and more will change what you pay. As a result, finding the best 2017 Medicare Advantage or Part D plan for you could save you hundreds, even thousands, of dollars.
Tip 4: Be Willing to Switch Pharmacies
The Walgreen’s down the street might be more convenient, but the CVS on the other side of town or your local grocery store could save you a wad of cash. The reason for this is simple: plans negotiate preferred pharmacy contracts, and they change over time. As a result, not only do you need to shop the plan with the best prices on the drugs you take, you also need to shop the lowest price by pharmacy.
The bottom line is that you may need to use a different pharmacy to get the best price.
Tip 5: Call Your Doctor’s Office
Your doctor’s office knows what plans they accept, including the plans they are dropping and adding in 2017. So, give them a call and ask to speak with the billing department. This will help you narrow plans to those your favorite doctor accepts. Otherwise, you could be looking at finding a new doctor.
Tip 6: Look at the Cost of Seeing Your Doctor
So far we’ve put emphasis on your medications. For most seniors, this is what appears to have the most impact. However, seeing your doctor or making an emergency room visit could take a bite out of your budget if you choose the wrong health plan.
This is why we publish what each plan charges for basic inpatient and outpatient services. In general, we feel that a co-payment (fixed amount) is better than a co-insurance (percentage of cost). With a co-payment, you will always know exactly what you owe when you see your doctor or visit the emergency room. With a co-insurance, you could be looking at a bill for up to 20% of the actual cost.
Look for the cost break down on our Medicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B).... pages.
Tip 7: The Best Health Plan Might be a Medigap Plan
If you are enrolled in Medicare Advantage, or you’re considering it, chances are it’s due to cost and your budget. We understand. But, maybe there’s an alternative you should consider.
Medicare Advantage is managed care health insurance that’s based on level of risk to both you and the carrier. For you the risk is what you will pay out-of-pocket before the plan begins to pick up the entire tab. This is called the Maximum Out-of-Pocket amount, or MOOP. For 2017, the highest MOOP a plan can have is $6,700.
Here’s an interesting and important fact. According to recent Kaiser Family Foundation research, nearly 50% of all seniors with a Medicare Advantage plan have a plan with a $6,700 MOOP. That means if you regularly see a specialist for a chronic condition or have an injury or illness that puts you in the hospital, you’re likely to be pulling $6,700 out of your pocket before the plan takes over.
If you can afford this risk, there’s a Medigap plan that offers complete health care flexibility and kicks in to 100% coverage when you’ve reached $4,940 in annual Out-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments..... It’s Medigap Plan K, and it’s worth looking at as an alternative, particularly if your Medicare Advantage plan options are limited.
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Choosing a Medicare plan can be confusing and intimidating. Following these 7 tips will make it easier for you to find the best plan(s) for you and your unique situation.