How to choose a Medicare Advantage Plan
聽for Medicare is underway through Dec. 7, so if you鈥檙e in the program and want to switch plans, now鈥檚 the time to shop.
Each year, more and more people choose privately run Medicare Advantage plans that work like traditional聽, rather than original Medicare. Thirty-one percent of Medicare beneficiaries are on a Medicare Advantage plan as of 2016, according to the Kaiser Family Foundation.
If you鈥檙e happy with your聽, you don鈥檛 have to change anything, but knowing all your options can鈥檛 hurt. Here鈥檚 how to shop for a Medicare Advantage plan.
Find Medicare Advantage plans in your area
Go to the聽聽on Medicare.gov. This website will ask for your prescriptions, but Patricia Barry, AARP Media features editor and author of 鈥淢edicare for Dummies, 2nd Edition,鈥� suggests you first do a search without inputting your drugs. (After answering the Plan Finder questions, choose not to enter your drugs now and continue on to the list of plans.)
鈥淓ntering the drugs first can distort the results,鈥� Barry says. The website may identify the 鈥渂est鈥� plans as those 鈥渢hat provide a good deal on drugs, but charge more for doctors鈥� visits and hospital stays than other plans,鈥� she explains.
Compare costs and benefits
Get cost information by clicking on each plan鈥檚 title, then on the 鈥渂enefits鈥� tab. Don鈥檛 look solely at premiums; look also at copays, coinsurance and the deductible. Often, a high deductible is the trade-off for a lower premium.
Pay special attention to how well each plan pays for services you use most 鈥� any plan that doesn鈥檛 cover your needs isn鈥檛 a good deal. If you need dental, hearing or vision benefits, look for plans with colored circles containing D, H or V.
HMO vs. PPO plans
Just like regular health insurance, Medicare Advantage plans are largely a mix of health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Sixty-four percent of Medicare Advantage enrollees choose HMO plans, according to the Kaiser Family Foundation, but you may prefer a different structure.
HMOs usually require you to select a primary doctor who coordinates your care. They also usually require a referral from that doctor if you want to see specialists. Often, HMOs pay nothing when you don鈥檛 use their doctors, except in an emergency.
A PPO will allow you to see any doctor you want, but you鈥檒l pay less if you choose an in-network doctor.
鈥淗MOs generally cost less but offer fewer providers to choose from,鈥� says Kip Piper, a Medicare consultant and speaker in Washington, D.C. 鈥淐onversely, PPOs offer more choice but at a higher cost.鈥�
An extra step to keep your doctors
Most doctors take original Medicare, but some do not take certain private plans like Medicare Advantage. If you like your doctors now, make sure they鈥檙e part of your plan鈥檚 network.
The easiest way to find out is to call the doctor鈥檚 office. The staff can tell you whether the doctor participates in the insurance plan you鈥檙e considering.
Now, make sure your drugs are covered
By now, your plan options should be narrowed to just a few. Write down the plan names and click on 鈥淓nter Information鈥� under the big blue buttons on the Plan Finder. Do the search again, this time entering your drug names.
The new results will include only plans that cover your prescriptions. If one or more of the plans you chose before are listed, these are your finalists.
Shoot for the stars
Medicare shoppers have one advantage over the rest of us: The star rating system, which tells you the quality of each plan on a one- to five-star scale. The ratings, determined by the Centers for Medicare & Medicaid Services, are based on several measures, such as benefits, customer satisfaction and how well the plan manages chronic conditions, Barry says.
The ratings system is new and isn鈥檛 perfect, Piper says, because it favors plans with healthier members. 鈥淧lans that serve more complex, high-needs patients tend to receive lower star ratings even though their real performance is likely quite good,鈥� he says.
Nonetheless, shoot for a star rating of 3.5 or better. After you鈥檝e selected a plan, you鈥檙e done 鈥� your old insurer (or Medicare) will be notified automatically of the switch.
Lacie Glover is a staff writer at NerdWallet, a personal finance website. Email:聽lacie@nerdwallet.com. Twitter:聽.
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