by Marc Manor
For a number of reasons you may be asking yourself if you should make a change to your Medicare Insurance or Prescription Drug Plan. I am often asked, “what do you think about this company” or “which company is best”? Because of Centers for Medicare and Medicaid Services (CMS) regulations, I am not allowed to impart my personal opinion in answering these types of questions. Agents are only allowed to state the facts when it comes these questions and besides, the question should be which plan is best for you in your situation based on your doctors, ongoing medical concerns, and the prescription drugs you are currently taking. When it comes to Medicare Insurance Plan performance, it’s all in the stars!
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Each Medicare Advantage (Part C) and Prescription Drug Plan (Part D) are assigned a star rating by CMS each year. That is the objective criteria we as agents can use to let you know how that company performs. The star ratings are assigned using a system of surveys that are compiled using information that is obtained from providers and members, among others. But star ratings alone are not the only indicator of whether you should make a change or not. Here are some things to think about before making a change:
Provider Networks - Plans have different provider networks. If you are currently under care of a provider or other specialists and you want to stay with them, this can be the most important aspect of your decision to make a change. Geographical locations of providers can also be important to some beneficiaries. Hospital networks, especially under an HMO plan may also be a consideration.
Benefits - It is important to compare the benefit schedules and make sure you are getting the most value according to your needs. Compare co-pays, co-insurance, and deductibles to your current plan. Many plans have extras such as gym memberships and dental benefits. Do they make sense with regard to the importance of these benefits to you and the services you use most frequently?
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HMO vs. PPO - A Health Maintenance Organization (HMO) operates under a tightly controlled referral network. Normally, the HMO plans do not provide coverage outside their network of Providers except in emergencies. Referrals under an HMO are required from a Primary Care Provider (PCP). A Preferred Provider Organization (PPO) is more loosely organized and while you will pay considerably lower co-pays and co-insurance staying within their network, there are options to go outside the network if required. Referrals are not normally required under a PPO type of plan which also provides more flexibility for the beneficiary. You can usually expect slightly higher co-pays etc. in a PPO as a trade-off for this flexibility. So, the question to ask is are you comfortable going to that PCP for each referral or do you find greater flexibility from a PPO provides greater peace of mind?
Prescriptions - Each Medicare Advantage Plan and Prescription Drug Plan has a formulary that determines the coverage for each drug. There can be significant differences even from the same company when they offer different plans. How do your prescriptions stack up in terms of coverage within those formularies? Do you know what pharmacies are in a network or which provide preferred pricing?
Price - By price I mean the monthly premium. I put this on the bottom for a reason. In many areas Medicare Advantage Plans are available for a low or even no monthly premium. Stand-Alone Prescription Drug Plans always have a premium, but the premium may be a lesser consideration as well when comparing the coverage for certain prescriptions.
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Many beneficiaries are overwhelmed with all these considerations. That is why I always recommend using an Independent Agent with access to multiple carriers that can find you the most appropriate plan. Independent Agents can take all your information and find a solution that fits even if it means staying in the plan you are currently using. When it comes to making a change to your Medicare Advantage or Prescription Drug Plan, a licensed Independent Agent will be able to explain your benefits in detail and help you decide if you should stay or you should go.
Marc Manor is a 30-year military veteran who is now dedicated to teaching his
fellow Americans how to make the most of their Medicare and Supplemental Insurance
benefits. As an independent agent, Marc has access to a wide variety of carriers with
an abundance of resources to find tailored solutions. There is no charge for a
consultation so call 904-222-0698 or email: marc@marcmanor.com.
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