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Health, Senior, Santa Monica, Senior Scene

Sorting Through The Medicare Advantage Maze

Posted Nov. 3, 2011, 6:26 am

Special To The Mirror

Ron Pollack

Executive Director Families USA

When the Affordable Care Act passed last year, you may have heard criticism that the health care law cut payments to Medicare Advantage plans.

Those are plans run by private insurance companies that contract with Medicare to provide all the benefits covered by the original Medicare program. Most of them also provide prescription drug coverage.

Medicare Advantage plans differ from original Medicare (for example, they often charge copayments for doctors’ visits that are a fixed amount, rather than a percentage). Some also provide benefits that are not covered by the original program. But they often have restrictions on which doctors and hospitals you can use.

The Affordable Care Act does reduce payments to Medicare Advantage plans. This is because independent experts found that these plans cost taxpayers much more than original Medicare—although they did not produce better results. So, starting in 2012, Medicare’s payments to these plans have rightfully been reduced. The big question has been this: How would plans react to these cuts?

So far, Medicare Advantage plans seem to be handling the reductions just fine. According to the agency that runs Medicare, over 99 percent of people with Medicare have access to Medicare Advantage plans for 2012, and the average premium is actually going down 4 percent. Medicare is also pushing plans to improve quality by offering bonuses to plans that score highly on quality measures.

What does this mean for people with Medicare? As always, it pays to be an informed consumer. Just because the average national premium is dropping, it doesn’t mean that your individual premium is going down too. If you have a Medicare Advantage plan, you should have received a notice from your plan telling you how it is changing for 2012. Plans can change important details, such as premiums, deductibles, copayments, drugs they cover, doctors and hospitals in the plan, and rules about what’s covered. Companies sometimes merge plans together, so your plan’s name may be changing, along with important details. Make sure to read the fine print.

If you are thinking of changing plans, or if you have original Medicare and are thinking of switching to Medicare Advantage, do your research. If you have a private Medicare supplement (“Medigap”) policy, or coverage from an employer, make sure you understand what will happen if you drop your coverage. You may not be able to get it back. Before you join a new plan, check costs and see if your doctors and other healthcare providers are in the plan. About 75 percent of people with Medicare have stayed with original Medicare, not a Medicare Advantage plan.

Also, think about the quality of the plan. Medicare rates plans on a five-star scale, based on factors like how often members get recommended screenings. It’s not a perfect measurement, but at least think twice about going with a plan that has fewer than three stars.

How do you learn what your choices are? Be cautious about sales pitches from agents or brokers who make commissions from selling to you.

If you use the internet, the Medicare plan finder at www.medicare.gov provides information about all your Medicare options.

Navigating the site can be difficult, but it’s usually up-to-date. If you prefer paper, everyone with Medicare should get a 2012 “Medicare and You” handbook that includes a list of all plans.

But the paper handbooks were printed before all the details about plans were available, so the information included is not complete. You can also call 1-800-MEDICARE to get information, to enroll in or change plans, or to ask for a referral to your local State Health Insurance Assistance Program (SHIP) for free, personalized counseling.

The Medicare enrollment period can be a confusing time. And remember, this year the enrollment period runs through Dec. 7. But take a deep breath and consider your options. You might be able to save some real money and improve your care.

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