Updated October
8, 2019 Philip
Moeller
Author, Get What's Yours books on
Social Security. Medicare, and, upcoming, Health Care; blogger for PBS
NewsHour; founder http://Insure.com .
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.
Supplemental benefits
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.
Medicare Advantage plans are now 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 transportation 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.
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.
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.
No comments:
Post a Comment