Should you change your Medicare Advantage plan?

October 15 – December 7 is the Open Enrollment Period for Medicare Advantage and Part D.  Everyone on Medicare is getting mailings from multiple companies promoting their “new and improved” Advantage plan. Some post cards say they can reduce your co-pays and out-of-pocket costs. For people enrolled in a Medicare Advantage plan, the question is: Should you shop around for a new plan for 2013?

I am an insurance broker and I’m not so sure you should bother – and here is why. If your plan’s co-pay to see a specialist has gone up $10, does that make you want to change plans? One plan has gone up to $50 for the specialist co-pay, but when I spoke to some of my clients about this, they said they are okay with it. Their biggest concern is being able to keep their doctors.  I could show them plans with $40 specialist co-pays, but I have to tell them this price will probably be good for just one year. Then the co-pay will go up.

There are plans with lower overall co-pays, but I have seen a pattern of Medicare Advantage plans starting out with lower co-pays and raising them each year.

One new plan in Tucson will pay about half of a person’s Medicare Part B premium, putting another $47 in that person’s Social Security check.  But here’s the catch with that plan: The co-pays and maximum out-of-pocket for that plan are higher than the company’s other plans. So this plan is designed for people who need money – but if they get sick, it will cost them more.  If they stay healthy, they end up with more money in their pocket.  If they get sick, they will have bigger bills and and a smaller bank account.

If you are thinking of changing plans, here are some important considerations:

Are all of your doctors in the plan network?  I was thinking one of the new plans in town would benefit a client of mine, but she has five doctors she sees and she wants to keep them all. Only three of her doctors are in the other plans’ networks, so they won’t work for her.

How are your drugs covered by the plan you are considering?  If you take only generic drugs, you should not have a problem – but brand drugs can be covered differently from plan to plan.  The co-pay might be $45 on one plan and $95 on another plan – for the same drug!

What do your doctors think about your plan and other plans in town?  Actually, the person to ask is the receptionist at the doctor’s office. She usually knows which plans the doctors like. The most common complaint is how difficult it is to get approval for tests and procedures. Doctors and their staffs are frustrated with some plans because of difficulties and delays in getting “prior authorizations”.

Some people shop for a new Advantage plan every year.  Others pick a plan and stay with it unless it changes drastically. The problem I see with Medicare Advantage is that new plans start out with the lowest co-pays and then go up and up every year.  I’m ready and willing to help people make a change, but I have to tell them their lower costs will not last for long.

Medicare has a rule that insurance agents cannot say, “This is the best plan!”. That’s any easy rule to follow because there is no “best” plan in Tucson. They are all just okay.


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