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Your essential guide to Medicare Advantage for 2013
It's open enrollment -- the period each year when you can choose or change your Medicare health and drug plans. You can enroll or change plans from Oct. 15 until Dec. 7. Whatever changes you make will take effect Jan. 1, 2013.
Medicare Advantage plans (also called Medicare Part C) are offered by private insurers and cover Part A (hospital stays) and Part B (doctor's visits). Most Medicare Advantage plans also include drug coverage.
If you choose a Medicare Advantage plan, you can't buy a Medicare supplemental insurance plan (known as Medigap) to pay for your out-of-pocket costs. If the Medicare Advantage plan you choose has drug coverage, you can't buy Part D drug coverage.
The federal government provides an online brochure about Medigap insurance.
Enrollment in Medicare Advantage to rise
More seniors than ever are expected to enroll in private Medicare Advantage plans for next year. Health and Human Services Secretary Kathleen Sebelius expects an 11 percent increase in enrollment. But alarmingly, a new study from the Kaiser Family Foundation found that one in four seniors aren't even aware of open enrollment.
The federal government expects the average Medicare Advantage premium to increase only $1.47 over 2012. That would bring monthly payments to an average of $32.59. The number of Medicare Advantage plan choices is expected to increase by 7 percent next year.
When Medicare Advantage plan originally started as an alternative to original Medicare, they were basically HMOs, which require subscribers to have gatekeepers to treatment (primary care physicians) to control costs, says Martin Rosen, co-founder of Health Advocate Inc., of Plymouth Meeting, Pa., a company that helps people navigate the health care system.
But Medicare Advantage plans have progressed. Today, Rosen says, you can find an Medicare Advantage plan that's a preferred provider organization (PPO).
Either way, with most Medicare Advantage plans you must use providers -- doctors and hospitals - - that are in their networks, says Rosen, co-author of "The Healthcare Survival Guide."
For some people that can be a disadvantage. The doctors you've been seeing for years may not be in the network, he explains. You may be able to go to a doctor outside the network, but you will pay more.
Also, Medicare Advantage plans are not available everywhere in the country, says Elaine Wong Eakin, executive director of California Health Advocates in Sacramento.
Steps before enrolling
Before you choose a Medicare Advantage plan, you should:
- Go online and find out which doctors and hospitals are in its provider network. Call your doctors' offices to find out if they take part in the Medicare Advantage plan you're considering. If they don't, decide if you're willing to change doctors or hospitals.
- Find out what happens if you go outside your coverage area. If you spend the winter in a warmer climate, you may not want to be limited by a Medicare Advantage network where you live during the summer, Rosen says.
- If you take prescription drugs, check to see whether they are on the plan's list of preferred drugs. If they aren't, you may be better off with original Medicare and a Part D drug plan that covers them.
- Find out what your out-of-pocket expenses will be. Deductibles, copays and co-insurance vary from plan to plan. Compare costs to other Medicare Advantage plans and also to original or basic Medicare and the supplements you would need. Medicare.gov has tips on things to think about when you compare Medicare drug coverage.
The best source of information on Medicare Advantage plans is the federal government's Medicare website.
"Think of it as the yellow pages for Medicare and Medicare Advantage plans," Eakin says. You can search for plans available in your area by entering your zip code.
Once you've determined which plans are available in your area and which you're interested in, reach out to them if you have questions, Eakin recommends.
Do your homework, Rosen says. "It's really important to be an educated consumer and make sure you're choosing something that's a good fit for you and your circumstances."
More from Beth Orenstein here