Treat Medicare Open Enrollment like you’re buying a car.
getty
Do you remember how much time you spent shopping for the last car you bought? One study said car buyers spend almost 15 hours.
Now, think about your Medicare Advantage plan. How much time did you spend checking that out? There haven’t been any official studies but, based on my observations over the last eight years, it’s probably an hour, maybe two at the most. Many beneficiaries I’ve talked with made the plan decision based on a commercial, a friend’s recommendation or something they got in the mail.
Granted, a car is a more expensive purchase and there are zero-premium Medicare Advantage plans just about everywhere. However, you need to know more. If you’re shopping for a plan during the Open Enrollment Period, October 15-December 7, think like a car shopper as you search and compare options.
Model
The number of existing car models in 2020 was estimated to be between 250 and 260.
In 2020, the average Medicare beneficiary has access to 28 Medicare Advantage plans with the numbers ranging from no plans in 71 counties to over 40 plans in 131.
Like convertibles, coupes, and SUVs, there are different types of Advantage plans. Here are the two most popular.
• Health maintenance organization (HMO): Almost two-thirds of Medicare Advantage enrollees are in HMOs. This type of plan usually limits coverage of services from doctors who work for or contract with the HMO. It generally won’t cover out-of-network (routine) medical care except in an emergency.
• Preferred provider organization (PPO): Just over 30% of enrollees are in PPOs. This plan provides flexibility to see doctors, specialists, or hospitals that aren’t in the plan’s network. You’ll likely pay more, in some cases, 40-50% of the costs. Also know that a non-network physician has no obligation to treat you, except in an emergency.
Price
Price is how much will you pay for the car.
In the Medicare Advantage world, that is the plan’s monthly premium. It’s very possible that you can find a zero-premium plan, one with no monthly premium. In 2019, half of those with Medicare Advantage plans did not pay a premium for the coverage.
Cost of ownership
A low price is definitely a plus but smart shoppers will check out the cost of ownership. The real costs for a car include insurance, fuel, maintenance, and more.
With Medicare Advantage, cost of ownership is how much you’ll spend beyond the premium. Check the plan details to learn your share of costs for the services you’ll need. For example, one PPO plan charges $25 for a primary physician visit, $50 for a specialist, and $360 a day for the first six days of hospitalization in-network and a straight 50% for out-of-network services. Just about every plan charges a 20% coinsurance for chemotherapy treatments.
By law, plans must have a maximum out-of-pocket limit. The maximum established by Medicare is $6,700 for in-network and $10,000 for in- and out-of-network combined. Think of this as the most you’ll pay if you have a really bad health year. These limits can vary considerably by plan and location. For instance, in Los Angeles, there are plans with a maximum limit of $999 and, in New York City, the lowest limits are around $4,500. Come January 1, the limit resets.
Features
Car buyers check out important features, like blind-spot warning, keyless entry, and info-tainment systems.
Medicare Advantage plans can offer extra benefits, including dental, vision, transportation, fitness, in-home support services, annual physical exams, massage therapy and more. Not all plans provide extra benefits and the ones that do, don’t provide everything and there can be limits. If interested, check a plan’s summary of benefits to learn more.
Quality
There are several different quality, reliability, and safety ratings for cars.
For Medicare Advantage plans, it’s the Medicare Part C Star Ratings. Find the overall quality rating on the Plan Finder pages for results and plan comparison. However, go beyond that to the specific data elements that will potentially have an impact on your plan experience, including customer service, ease of getting appointments and seeing specialists, and members’ rating of and experience with the plan. Find these star ratings at the bottom of the plan details page in the Plan Finder.
Rules of the road
Once you own a car, you must follow the rules of the road – speed limits, seat belts, parking restrictions, and more.
Likewise, Medicare Advantage plans have rules that govern what the plan will cover and how much you’ll pay. You may need referrals to see physicians other than your primary. There can be plan limits and advance approval required. (In 2020, 99% of enrollees faced prior authorization for one or more services.)
Trade-in
The best time to trade an old car for a new one is shortly before the new models arrive.
In the Medicare world, trade-in time starts October 15. Every year, before Open Enrollment, you’ll get information from your current plan about the changes in coverage and cost for the next year. Shortly after that, the Medicare Plan Finder will update the list of plans.
Think like a car shopper. Do your research, compare features and costs, check out the quality, and make a decision by December 7. Don’t miss your chance to trade-in for a new, improved model.