If you are a Medicare patient, you have undoubtedly noticed a recent torrent of ads from Medicare insurance providers. This is an annual event, coinciding with Medicare’s Open Enrollment Period, which runs from October 15 to December 7 of each year. During this period, seniors can easily sign up for a new plan, switch plans or leave a plan. When the enrollment period ends, all of these options become more difficult, if they are available at all.
During this time, seniors may enroll in a Medicare Advantage Plan if they have been enrolled in original Medicare (Parts A and B) or move from one Medicare Advantage Plan to another. These Medicare Advantage or “MA” plans are rapidly growing in popularity. In fact, enrollment in MA plans has doubled in the past decade, and the Congressional Budget Office predicts that nearly half of all Medicare beneficiaries will be in MA plans by 2029. There are good reasons for this trend.
It has always been the case that medical professionals have felt that managed care could be better care. Recently, the government has taken action to make MAs more attractive to senior consumers, encouraging competition and reducing insurance costs. This increased competition has resulted in Advantage Plans that cover all the benefits offered by original Medicare, including Rx drug coverage plus many extras.
Here is some surprising (and very good) news—these measures have produced results! Since 2017 the average monthly premium for a Medicare Advantage plan has gone down by 34% nationwide. All of this sounds great, but there is a catch. Medicare Advantage Plans are products of the private health care insurance industry. There are literally hundreds of different plans to choose from, so how can seniors determine which plan is best for them?
Medicare itself can be a big help when making this decision. The CMS has developed a program that tracks the performance of all Medicare Advantage plans. This “Star Rating System” provides a quality score to Medicare Advantage organizations, rating them on a 5-star scale. Plans that receive a 5-star rating are the best performers. These ratings, based on the plan’s performance on several benchmarks, encourage all plan providers to place seniors’ interests first. These quality standards for medical care include:
- Seniors’ reported experiences with the plan
- The number of seniors leaving the plan over the previous year—the fewer who leave, the higher the rating
- The use of screenings and immunization to maintain good health
- How well the plan does in managing chronic, long-term conditions
- The overall quality of care for plan members
For Rx drug coverage, the standards include the accuracy of pricing information, how well the plan’s customer service representatives handled questions and complaints, the number of members reporting issues with the plan and how well seniors adhered to the prescription instructions. Most Advantage Plans include coverage for Rx drugs.
Several 5-star plans are available in Florida, but the availability of Medicare Advantage Plans varies from one location to the next, even from county to county in the same state. Seniors should research this before committing to any one plan. Advantage Plans establish local networks of doctors, pharmacies, hospitals and other providers. The details, even for plans with the same names, can vary by location. Below are the names of 5-star rated plans in OurSeniors.net’s coverage area for 2021.
- CareComplete (HMO C-SNP) CarePlus Health Plans, Inc.
- CareFree (HMO) CarePlus Health Plans, Inc.
- CareOne PLATINUM (HMO) CarePlus Health Plans, Inc.
- CareOne PLUS (HMO-POS) CarePlus Health Plans, Inc.
- Cigna Preferred Medicare (HMO) Cigna
- Cigna Preferred Savings Medicare (HMO) Cigna
- Humana Gold Plus H1036-044 (HMO) Humana
The blizzard of advertisements mentioned above can cause confusion and anxiety, leading seniors to make poor choices. Some Advantage Plans advertise that they have a monthly premium cost of $0.00. This is true of some plans, but they are sure to contain fewer benefits than plans that include a monthly premium. Sometimes, these zero premium plans are suited to younger seniors, but as they age, benefits to not keep pace with needs.
Seniors may go to the Medicare.gov website and fill in the required data to view a complete list of Advantage Plans available in their area. However, many of these situations require the knowledge and experience of an insurance professional. They will know the local conditions, networks and available plans. CMD Insurance Agency is a group of professionals with more than 25 years of experience in heath insurance and they can assist you if you need guidance. Click on their link to find out more.