Having completed the stand-alone Medicare Part D (PDP) evaluation for my mom (assuming she will stay with original Medicare), I am now ready to see if a Medicare Advantage plan (Medicare Part C) is a choice for her. Making Medicare health plan choices is a much more complex endeavor and should not be taken lightly. In my mom’s case, I originally thought she had three different combinations of Medicare insurance plans/policies to consider. After reading the 132 page Medicare & You 2017 handbook, I discovered that Choice 2 in the figure below. was NOT ALLOWED (see pg 85)! Although my mom cannot use this combination of Medicare coverage, I am still going to analyze the costs to see how it compares to the MA-PD plans. The Medicare Part D in the figure is the stand-alone Part D prescription drug plan (PDP).
My mom presently has the first combination in the above figure (with a supplemental Medigap F policy). Remember that Medicare Advantage (Medicare Part C) is simply original Medicare (Parts A and B benefits) managed by a private for-profit insurance company. A Medicare beneficiary must have both Medicare Parts A and B to buy a Medicare Advantage plan—the Part B premium you pay will simply be given to the insurance company instead of going to the Medicare coffers. In the figure above, all the green lettered plans/policies are managed by private for-profit insurance companies. Only original Medicare is run by the federal government.
My Mom’s Medicare Health Plan Choices
I invite you to go back to my first blog post in this series (BB’s Medicare Open Enrollment: Where Do I Begin?) and follow the steps to get to the Summary of Your Search Results as shown below.
I have selected the second (Medicare Health plans with drug coverage) and the third (Medicare Health Plans without drug coverage) and clicked the Continue to Plan Results.tab. I am greeted with the 10 Medicare health plan choices available to my mom along with her current Medicare health plan (Original Medicare). Original Medicare is a health plan without drug, dental, vision or hearing coverage.. The cost information in the figure below does not include the benefits my mom gets from her Medigap F pollicy and her stand-alone Part D plan.
The monthly premium and Part B deductibles shown on the website are incorrect because the government just announced the 2017 costs on November 11th. I have updated the information in the figure.
In the figure below, you can see my mom’s first two Medicare health plan choices are Medicare Advantage with drug coverage plans (MA-PD). They are sorted by Lowest Estimated Annual Health and Drug Cost. The cheapest Medicare health plan choices are HMO plans. An HMO plan requires that beneficiaries use a restrictive, localized network of plan doctors/hospital(s) for all covered services.
Two of my mom’s nine MA-PD plan choices are under a sanctioned cloud ( HMO-POS and HMO plans owned by Cigna HealthSpring) and cannot be purchased. The remaining seven MA-PD plans are sold by three insurance companies; namely, Anthem Blue Cross and Blue Shield (HMO and Regional PPO plans), UnitedHealthCare (2 HMO plans), and Humana Insurance Company (PPO and Regional PPO plan).
My mom only has one available Medicare Advantage plan without prescription drug coverage (MA). Most people across the United States will only find one MA plan available because the insurance companies do not want you to sell them and the federal government makes them offer at least one per zip code. This MA plan is a “PPO” and CANNOT be used with any of the 21 stand-alone Part D prescription drug plans (PDP) available to my mom per page 85 of the Medicare & You 2017 handbook. Interesting…
Medicare Health Plan Choices–The Details
In the next several figures, I have selected three of the MA-PD plans (the cheapest HMO and two Regional PPOs) to show a side-by-side comparison under various headings.
The only reason to go to the Overview tab is to access three important links; namely the link to (1) Visit plan website (for important plan documents like the Summary of Benefits, Evidence of Coverage, Formulary, appeals process); (2) Visit provider and physician network website (Medicare Advantage plans have restricted doctor /hospital networks); and (3) View a chart. Read the plan documents VERY CAREFULLY–Medicare Advantage plans are for-profit and that means the less they pay out, the more money they make for the company and its employees! You need to always remember that Medicare Advantage plans pay brokers to sell their products and the higher the reward, the more likely you are to get a hard sell for one product over another. These brokers will not give you an unbiased evaluation for all your Medicare health plan choices which is why you must get the information on your own. Buying a Medicare Advantage plan is very much a buyer beware situation! These three links are circled in red above.
Health Plan Benefits Tab
Under the Health Plan Benefits tab, you will find the greatest amount of cost information for your Medicare health plan choices. The figure below shows the expanded Costs and Other Important Information for three MA-PD plans.
Note the red circled information.
(1) The Monthly Health Plan Premiums do NOT include the Medicare Part B premium ALL Medicare Advantage plan beneficiaries MUST pay.
(2) The Maximum Out-of-Pocket does NOT include out-of-pocket costs from the prescription drug coverage part of the MA-PD.
(3) Although the HMO has a lower Maximum Out-of-Pocket (in-network), going out-of-network in the HMO means you will pay the FULL cost of health services out of your pocket. The HMO beneficiary needs to always ask before treatment if the medical professionals/hospitals are part of the HMO’s network.
(4) Under Choice of Doctors, for the non-HMO Medicare Advantage plans, any doctor does not mean any doctor in the United States, but simply means that you will have more doctors to choose from than if you were in a Medicare Advantage HMO.
(5) Under Optional Supplemental Benefits, it should be noted that the two Anthem plans will provide extra $500 dental coverage for an additional $18 monthly premium. This is ADDITIONAL coverage that can be bought if desired. It is not part of the health plan dental coverage (one oral exam and one dental cleaning per year). A combined dental + vision coverage for an additional $25 monthly premium is also offered.
The last area to expand under the Health Plan Benefits tab is the Benefits details as shown below.
In Medicare Advantage plans, you will be paying a cost-share (copays and coinsurance) for most services.You should look closely at the cost-share in the most expensive services (e.g., hospital care, renal dialysis). For example, calculate what a five or six day stay in a hospital would cost you for each of the Medicare health plan choices. I don’t spend much time looking at the rest of the details.
If I wanted to evaluate my mom’s second Medicare health plan choice above (i.e., getting an MA plan with a stand-alone Part D plan), then my comparison would be between original Medicare and the one MA plan on offer (shown below for cost and benefits).
I have already evaluated the stand-alone Part D plans in my earlier blog post.
If you cannot afford to buy a Medigap policy to supplement original Medicare, then you need to note the differences between the plans above for best value. Your choice of doctors is much greater in original Medicare and is nationwide. Unlike original Medicare, the Medicare Advantage plan does have a maximum out-of-pocket (this is catastrophic coverage).
Drug Costs & Benefits Tab
It is interesting to compare the estimated drug costs in the MA-PD plans above with the cheapest stand-alone Part D plan (Wellcare Classic) in my earlier evaluation, my mom’s estimated drug costs in the Wellcare Classic plan would be $526 (at CVS) and $482 mail order. Now I know why insurance companies do not want to sell MA plans.
When I evaluated the stand-alone Part D plans, I was only interested in the star ratings for the Prescription Drug Plans, but now I am interested in looking at the details under Health Plans Star Ratings (see the figure below).
The Star Ratings evaluate the management of a Medicare health plan (original Medicare is unmanaged) and our government is continuously trying to find a combination of measures that will define health plan quality for the delivery of healthcare value. Some of the categories in the Star Ratings bother me because they reward the insurance company when patients get various screenings and manage chronic conditions. They give Medicare Advantage companies EXTRA cash (out of Medicare funds) to perform these functions that I think should be incentivized on the doctor and patient level only. I think the Star Ratings serve insurance company profits more than they serve as a measure of the highest quality Medicare Advantage plan. When our government finds a plan unsatisfactory, it is supposed to close it down. Lobbying efforts by companies selling Medicare Advantage plans often delay or even stop this consumer protection safeguard.
Summing Up Medicare Health Plan Choices
I have presented an outline of how I navigate the government’s “Medicare Plan Finder” to help me decide whether my mom should totally change her present original Medicare + Medigap F policy + stand-alone Part D drug plan combination to a private Medicare Advantage plan. If you are seriously thinking of switching from original Medicare to a Medicare Advantage plan, my advice is to VERY CAREFULLY read as many of the plan’s documents as you can and take notes about possible red flags. Read the Medicare & You 2016 handbook also. This preparation is very important BEFORE talking to a insurance agent, who will only point out the selling points of the plan that pays him or her. In my next blog post, I will take the information above along with my mom’s particular desires and needs and evaluate how I will proceed.
Where To Get Unbiased Medicare Plan Advice
BB’s Medicare Open Enrollment: Where Do I Begin –how to navigate the government’s Medicare Plan Finder website
BB’s Medicare Open Enrollment: Stand-Alone Prescription Drug Plans –assuming mom stayed with original Medicare
Zeroing In On The Cheapest Medicare Part D Plan –assuming mom stayed with original Medicare
Evaluating Medicare Choices For Mom–Conclusions –learn why my mom chose to stay with original Medicare + Medigap F policy + the cheapest stand-alone Part D plan instead of changing to Medicare Advantage