Phil Moeller is doing a series of special pieces to help Considerable readers get ready for Medicare’s annual open enrollment period, which begins Oct. 15 and extends through Dec. 7. During this period, more than 60 million people who already have Medicare can keep their plans or totally change them for 2020.
Medicare Advantage (MA) plans can be a great lower cost Medicare solution, especially compared with a package that includes basic Medicare, a Part D drug plan, and a Medigap supplement plan. About a third of Medicare enrollees are now in MA plans and two-thirds have basic Medicare.
People in both situations must pay the monthly Part B premium. It is $135.50 this year and the 2020 cost will be announced in the next week.
Beyond that, the additional cost of an MA plan that includes a Part D plan can be much less than what someone with basic Medicare would pay for a Part D plan and a Medigap policy.
In addition, MA plans are allowed to cover limited dental, hearing, and vision expenses, whereas basic Medicare is not permitted to cover these items. Most MA plans also cover gym memberships.
In the past two years, MA plans also have been permitted to cover so-called supplemental benefits — things that clearly improve health outcomes but which are not purely medical in nature.
Items already covered by some plans include transporation to health appointments, home-delivered meals to people recently released from hospitals, and in-home safety items such as bathroom grab bars.
Right now, most insurers are making only limited use of new supplemental coverage. They want to see how people respond to these benefits before expanding them. This will also provide insurers needed cost information so they can profitably price their plans in the future.
These benefits are part of a broader health care focus on what are called “social determinants of health.”
It’s already well known that we can save people and the health system enormous amounts of money by reducing the need for care through programs that provide people with improved nutrition, transportation to medical appointments, and community enrichment activities that combat social isolation.
If these benefits are important to you right now, then you should use open enrollment to see if there are MA plans in your area that offer them. The Medicare Plan Finder does not make this easy, however, and you likely will need to call individual insurers to find out about their offerings.
Basic Medicare vs. Medicare Advantage
Basic Medicare permits people to use any health care provider in the country who accepts Medicare, and nearly all of them do.
By contrast, a major way that MA plans can afford to charge less than basic Medicare while still covering more things is their creation of limited health care provider networks with geographic coverage boundaries.
For this reason, the key to whether an MA plan is right for you is whether a plan’s network of doctors, hospitals, and other health providers meets your needs.
There have been big problems with these networks. It can be very hard to find out exactly who’s in a plan’s network. The accuracy of insurer network directories has been unacceptably spotty.
Further, a doctor can be in a network when you enroll in your plan, but either the doctor or the insurer may change their mind by the time you need to see that doctor. Stronger consumer safeguards against these problems need to be put in place.
In sum, if you are OK with a plan’s provider network and its geographic coverage area, MA deserves a serious look. If not, basic Medicare may be a safer although costlier option.