Essential Information to Shop For Medicare Advantage Drug Plans

It’s that time of year for older adults looking to find a Medicare Advantage managed care or prescription drug plan for 2021. Open enrollment begins Thursday, Oct. 15, for the Medicare Advantage managed care plans and Medicare Part D prescription drug plans. They are available for everyone covered by Medicare, the federal health insurance program for people 65 or older and some younger disabled Americans. 

Essential information to shop for medicare advantage drug plans

Enrollment will continue through Dec. 7. Changes are effective Jan. 1. 

Consumers can choose to include prescription drug coverage in Medicare Advantage plans or may want a separate Medicare Part D prescription drug plan to use with original Medicare or a Medicare supplemental plan, also called a Medigap plan. 

It’s that time of year for older adults looking to find a Medicare managed care or prescription drug plan for 2021. 

Open enrollment begins Thursday, Oct. 15, for the Medicare Advantage managed care plans and Medicare Part D prescription drug plans. They are available for everyone covered by Medicare, the federal health insurance program for people 65 or older and some younger disabled Americans. 

Enrollment will continue through Dec. 7. Changes are effective Jan. 1. 

Consumers can choose to include prescription drug coverage in Medicare Advantage plans or may want a separate Medicare Part D prescription drug plan to use with original Medicare or a Medicare supplemental plan, also called a Medigap plan. 

Don’t assume your plan from last year will have the same benefits this year or that it is the best plan for you for 2021, she said. 

“Look and see what else is out there. If the plan you’re on is still going to be the same thing and you want to stay, you don’t have to do anything else,” Reeg said. “You automatically reenroll unless you tell Medicare. The good thing is you will never go without Medicare. Ideally, you’ve made the proactive decision to what plan to be in.” 

Look at the costs of services you use most, like specialists or medications, when comparing Medicare Advantage plans, said Francine Chuchanis, director of entitlement rights for Direction Home Akron Canton Area Agency on Aging & Disabilities, who reviews the Medicare Advantage plans offered in several area counties yearly. 

“I also think it’s important that beneficiaries call their doctors and ask them which plans they accept” because that could change yearly, Chuchanis said. 

It is especially important to look at the total yearly cost of plans, including premium and drug costs, as well as out-of-pocket limits, when weighing the best plan for you, she said.  

New this year for Medicare Advantage and Part D plans are what’s called Senior Savings Models, which focus on insulin prices for no more than a $35 per month copay. Click on the “insulin savings” filter to find those plans when searching on www.medicare.gov 

Also new this year, patients with end-stage renal disease can get a Medicare Advantage plan. 

Patients should still check their total costs when looking at plans for insulin savings or end-stage renal disease coverage to determine which is the cheapest overall, Reeg said. 

Likewise, zero-premium plans can provide good coverage for consumers, but make sure you look at all of the out-of-pocket costs, experts said.

Unlike the old adage of “you get what you pay for,” there are many zero-premium Medicare Advantage plans with good coverage because Medicare pays plans to participate and subsidizes some costs, Reeg said. 

Consumers have to choose a plan based on their current health needs for the next year, as well  potential costs “if you have the worst health year ever,” she said. 

“Health insurance is based on the ‘if.’ You want to know what’s going to happen if you are in that situation and knowing what your copay should you be admitted to the hospital,” Reeg said.

Many Medicare Advantage plans offer extra benefits for dental, vision and hearing and other “extras” such as home and bath safety devices or emergency response devices. 

“I get excited about freebies, but you have to realize these are health plans,” Reeg said. “We really want them to make that decision based on the health plan and the coverage for their medical and health benefits.”  

Similarly, spouses need to review their plans individually and often have to pick different ones, said Reeg. 

The Medicare Part D drug plans are offered statewide; the Medicare Advantage plans vary by county. 

The federal government contracts with private insurance companies to provide drug and/or medical coverage to Medicare recipients who sign up for the plans. Everyone but the poorest enrollees pays a portion of the monthly premium; the government picks up the rest. 

For 2021, more than 2.3 million Ohio residents covered by Medicare can select from among 30 Medicare prescription drug plans, also known as Medicare Part D plans. There are 202 Medicare Advantage plans available in Ohio, up from 178 plans last year. The number of plans available in each county will vary, depending on what providers offer coverage. 

Nationally, Medicare Advantage continues to be popular, with enrollment projected to increase to an all-time high of 26.9 million beneficiaries from the current enrollment of 24.4 million, according to the Centers for Medicare and Medicaid Services. The projected enrollment for 2021 represents a 44% increase in Medicare Advantage enrollment since 2017. 

In Summit County, there are 77 Medicare Advantage managed care plans available that provide help paying for doctor visits, hospital stays and other medical services. That is 13 more plans than in 2020. All but 11 include prescription drug coverage. 

In Summit County, 38 Medicare Advantage plans have no monthly premiums for enrollees.

Consumers are encouraged to use Medicare’s quality star ratings to help evaluate plans; however, the Medicare website did not have the star ratings available by press time. Managed care and drug plans are rated on a 1 to 5 star scale, with 1 star representing poor performance and 5 stars representing excellent performance. 

This year, there are two more Part D prescription plans in Ohio than last year, for a total of 30. 

Part D plans cover prescription drugs for consumers who are not on a Medicare Advantage plan, which usually includes prescription drug coverage. 

The cheapest monthly premium is with SilverScript SmartRx, which is $7.30 a month. However, similar to Medicare Advantage plans, experts caution about choosing a plan based solely on the price. Make sure to check whether your prescription drugs are covered and at what cost. 

Originally published by BeaconJournal

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