Editor’s Note: Wednesday marks the third week of Medicare open enrollment and the third week of Making Sen$e’s new Medicare column, “Ask Phil, the Medicare Maven.” Philip Moeller, who writes widely on health and retirement, is here to guide readers through open enrollment, which ends Dec. 7, and he’s taking your questions about all things Medicare related.
— Simone Pathe, Making Sen$e Editor
Today, the doctor is prescribing a dose of Medicare Advantage. With apologies, he will repeat some Medicare medicine from previous Ask Phil pieces about this year’s Medicare open enrollment period, including an overview of changes for 2015, what’s going on with Medicare Part D prescription drug programs, and how to use Medicare’s Plan Finder to get the best prescription drug coverage for your precise mix of medications.
Medicare Advantage (MA) are private plans technically known as Part C of Medicare. They emerged in their present form following implementation of Medicare’s prescription drug program (Part D) about 10 years ago. MA plans must offer services covered in basic Medicare (Part A, which covers hospitals, and Part B, which includes covered charges for doctors, outpatient services and medical equipment). Most MA plans also offer Part D drug coverage.
MA plans became popular because many of them offered coverage that exceeded basic Medicare, often including vision and dental benefits. The MA plans could afford to offer these benefits at attractive rates because the government subsidized them to encourage private insurers to offer the new plans.
Despite the reduction in subsidies in recent years, the plans have grown in popularity because they continue to offer enhanced features. In 2014, about 30 percent of Medicare beneficiaries, or 15.5 million people, had MA plans.
Is Your Plan Even Still Around?
Insurers make a lot of changes to existing plans each year, so you really should look up your plan and see how it will be treating you next year. How have drug deductibles and co-pays changed? Are all your medicines even still covered? What about details of vision and dental coverage? And are there other “extra” coverages that have either appeared or disappeared?
This assumes, of course, that your plan will still be offered next year. Plans enter new markets and exit old ones every year. If your current plan will no longer be offered next year, you should have received a notice to that effect. And you should have read it. Maybe you did and maybe you didn’t. We’re not taking names here. But if you don’t know, you can find the list of 2015 plans offered where you live by using the Medicare Plan Finder or by calling your local State Health Insurance Assistance Program office.
Only 4 percent of MA enrollees are in plans that will not be offered next year, according to an analysis by the Kaiser Family Foundation. But this national average masks bigger adjustments in some states. More than 10 percent of MA users in eight states will see their plans go away at the end of the year: Connecticut, Hawaii, Idaho, Maryland, Montana, North Carolina, New Hampshire and Vermont. And in Hawaii, Kaiser says, nearly two-thirds of MA enrollees will have to find a new plan for 2015, primarily due to the exit of a single large insurer’s plan. (A state-by-state listing of MA plans leaving and entering the market in 2015 is at the end of this Kaiser briefing paper.)
Are Your Doctors and Local Hospitals Still in Your Plan?
Nearly two-thirds of MA plans offered next year will be HMOs (health maintenance organizations), continuing their emergence as insurance company favorites. For one thing, insurers like the cost-savings and control of HMOs. They can select which doctors and hospitals are in their network. And they can, and often do, levy steep additional charges on people who go outside of their networks for treatment.
Also, and this is a nasty asterisk for MA plans, insurers do not have to wait until a new plan year to change their network line-ups. So, even if you make the perfect MA plan selection, you can be on the wrong end of an insurer’s scalpel if it decides your doctor or hospital no longer makes the grade. To be fair here, doctors and hospitals are hardly helpless or faultless here. They have their own market power, particularly at the local level. Negotiations about network members are thus often heavyweight bouts.
Now, you may not even know if your MA plan is an HMO. But whether it is or not, one of the first things you should do when evaluating your MA plan for 2015 is call the offices of the key doctors you depend on for care. If you want to do the “full Monty” of consumer shopping, you should ask them which MA plans they participate in. At the very least, make sure they’re in the network of the plan you now have or, if you’re new to Medicare, the plan you’re considering.
If you find that your current MA plan is no longer the best for you, you have until Dec. 7 to select any other MA plan offered in your service area.
If you decide none of the MA plans are good dance partners, your game of Medicare Monopoly will enter a new round. There is a special enrollment period from next Jan. 1 through Feb. 14 for people who no longer wish to be in any MA plan. During this period, you can select original Medicare (Parts A and B). And, if your MA plan also included prescription drug coverage, you can select a stand-alone Part D prescription drug program as well.
One of the strong selling features of many MA plans is that they plug a lot of holes in basic Medicare. Historically, people had to turn to Medigap insurance plans, which, as their name suggests, fill the coverage gaps in basic Medicare. So serious Medicare shoppers need to compare their MA plans with their Medigap options to see what makes sense for them. Next week’s Ask Phil will do just that.