By WALECIA KONRAD MONEYWATCH August 28, 2017, 5:00 AM
in
As if
there isn't enough to worry about when it comes to finding health insurance,
add this item to the list: Medicare Advantage.
Changes
in plan structures and a dearth of insurers in rural areas may leave consumers
with fewer choices and more confusion in the upcoming Medicare open enrollment period,
which begins October 15.
Medicare Advantage plans, offered by private insurers, provide
traditional Medicare coverage and often offer additional benefits such as
dental, vision and Medicare Part D prescription drug coverage. Premiums,
deductibles and co-pays vary significantly from plan to plan, so comparing
costs and coverage each year — even if you are already enrolled — is critical.
Medicare
Advantage is different from Medigap, which is designed to help fill the gaps in
traditional Medicare coverage.
In the
recent past, some Medicare Advantage plan members have been struggling to find
the care they need, especially those who have acute or chronic illnesses. About
one-third of people eligible for Medicare enroll in Advantage plans. A
recent Government Accountability Office report found that a large number of
Medicare Advantage enrollees, especially those in poor health, drop out of the plans because they have trouble getting
access to the care they need. Of the 126 Medicare Advantage plans studied, the
GAO found 35 of them had disproportionately high numbers of sick people
dropping out.
If you
are part of a Medicare Advantage plan or considering Medicare Advantage in the
upcoming sign up period, or if you are taking care of a loved one with MA
coverage, here's a preliminary glimpse at what you need to watch out for in the
year ahead.
Look
for changes in your existing plan. If you're already
enrolled in a Medicare Advantage plan, your insurer will likely send you
information soon regarding 2018 plan details. Read this carefully. "Just
because a plan works for you this year doesn't mean it will necessarily work
for you next year." warned David Lipschutz, an attorney at the Center for Medicare Advocacy. Many insurers change their
cost-sharing, premiums and prescription drug formularies (the list of drugs
covered by the plan) each year, Lipschutz explained. Look closely at any
changes your plan is implementing and compare that to other plans available in
your area. Existing Medicare enrollees and first-time shoppers can compare
Medicare Advantage plans and traditional Medicare on Medicare.gov.
Check
your health network. Like all health insurance plans, Medicare
Advantage insurers negotiate with hospitals, doctors and other health care
providers to find the lowest cost providers each year. Those networks — both
health maintenance organizations and preferred provider organizations — are
subject to change every year. In recent years, these provider networks have
become smaller, with fewer specialists. These changes were among the main
reasons Medicare Advantage enrollees dropped out of their plans, according to
the GAO report. Always check to make sure the network on your plan or the plans
you are considering include the providers you need to stay healthy. And check
to see if more of the providers you need are available to you through
traditional Medicare.
Rural
consumers may be out of luck. Much has been said about
rural counties left with only one or no insurance options on the Obamacare
exchanges. State insurance commissioners, insurers and others have been working
hard to successfully fill those gaps. In the meantime, the real dearth of
coverage may exist among Medicare Advantage insurers. According to a recent report from the Kaiser Family Foundation, 147 counties,
across 14 states have no Medicare Advantage insurer this year.
If you
live in an area with no Medicare Advantage insurer you'll need to take the time
to thoroughly understand traditional Medicare coverage and decide if a Medigap policy is right for you.
Get
help while you still can. Your State Health
Insurance Assistance Program (SHIP) can help you sort through your Medicare
options and compare Medicare Advantage plans. SHIPs are funded through the
federal government and provide free health care counseling for Medicare
recipients. The Trump Administration's budget proposal would cut funding for
SHIPs entirely, Lipschutz said. He suggested starting your health plan search
now while this resource is still available. To find the SHIP in your state,
click here.
https://www.cbsnews.com/news/medicare-advantage-plans-2018-finding-health-insurance/
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