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Choosing a Medicare Advantage plan for 2019

You can choose a Medicare Advantageo plan during the annual open enrollment period or when you're first offered Medicare when you turn 65. 

If you have a Medicare Advantage plan, you'll also receive your annual notice of change (ANOC) from your plan. Medicare Advantage plans are required to tell you of any changes for the upcoming year before the Medicare open enrollment period that runs each year from Oct. 15-Dec. 7. If you don't make changes during that time, you won't be able to switch until the next open enrollment period unless you face a qualifying life event. A qualifying life event includes a spouse's death, retirement or change of job. 

Don't ignore open enrollment, advises Pamala McIntire, a benefits consultant for Reames Employee Benefits Solutions in Daytona Beach, Fla. The notice will tell you of any changes in the plan's costs, benefits, coverages or service areas and rules for the upcoming year.

Medicare Advantage 2015If you are OK with the changes, you don't have to do anything. But if you're dissatisfied or want to change to a different Medicare Advantage plan, open enrollment is the time. It's also time for people with Original Medicare to change to a Medicare Advantage plan and vice-versa.

Medicare plans vary on who handles your claims. With Original Medicare, the government pays your healthcare providers for your Part A and/or Part B benefits.

Medicare Advantage plans are a type of Medicare offered by private companies. The companies contract with Medicare to provide you insurance. Most Medicare Advantage plans are health maintenance organizations or preferred provider organizations.

However, some Medicare Advantage plans are private fee-for-service plans.

The vast majority of Americans have access to at least 10 Medicare Advantage plans. This means you can often find a plan that best suits your situation. 

Medicare Advantage plans have lower premiums

The advantage to buying a Medicare Advantage plan is that you likely pay less in monthly premiums than you would for supplemental plans, called Medigap, and traditional or Original Medicare, says Tracey Fults of Medicare 411 Company in Rockford, Ill.

Medicare Advantage premiums have fallen over the past few years. For 2019, the average monthly premium will drop 6 percent to $28. About half of Medicare Advantage enrollees don't pay any premiums.

The cost of the plans can vary depending on where you live. 

Costs for 2019 Medicare Advantage plans

The Centers for Medicare & Medicaid Services (CMS) forecasts that average premiums for 2019 Medicare Advantage plans will decrease by 6 percent compared to 2018.

The trade-off to a low premium is that you might have higher deductibles and co-insurance when you need healthcare. Also, you will pay more or may not have any coverage if you use doctors and hospitals that aren't part of your Advantage plan's network.

There are about 3,700 Medicare Advantage plans across the country and 22.6 million people are expected to have Medicare Advantage coverage in 2019. That's about 36 percent of Medicare beneficiaries. 

Starting in 2019, Medicare Advantage members will have more access to supplemental benefits. About 270 plans that provide coverage to nearly 1.5 million enrollees will have expanded benefits, including adult daycare services, in-home support services and home-based palliative care.

Plans will also have other additional benefits, such as reduced cost sharing for people with diabetes and congestive heart failure. 

Not all Medicare Advantage plans will have these supplemental benefits, so check to make sure to ask the plan about supplemental benefits before enrolling. In the coming years, more Medicare Advantage plans will have these kinds of add-ons. 

Drug coverage likely included in a Medicare Advantage plan

Most, but not all, Medicare Advantage plans provide prescription drug coverage.

If you have Original Medicare, you can buy a Part D drug coverage plan separately. However, you can't buy a Part D plan if you have a Medicare Advantage plan. Instead, look for a Medicare Advantage plan with drug coverage. 

Separate Part D plans will average about $35 a month, so expect you will need to pay more for a Medicare Advantage plan with prescription drug coverage. 

What to look for when choosing a Medicare Advantage plan

Here's what to do when choosing a Medicare Advantage plan:

Look at what doctors and hospitals are in the plan's network. Provider networks can change each year and even mid-year, McIntire warns. If you visit particular doctors or hospitals, make sure they're part of the plan you choose.

"You do have to stay within the network for the most part," McIntire says. "However, most Medicare Advantage plans are very good about getting you where you need to go. If they don't have the specialist you need in their network, they will get you someone."

Not all providers accept Medicare Advantage. Your long-time doctor may accept Original Medicare, but that doesn't mean the physician accepts a specific Medicare Advantage plan. It's best to check with your physician's office before signing up with a plan just to make sure. 

Look at drugs and your usage when selecting plan. If you're taking prescription drugs, examine the plan's list of covered medications carefully.

"The costs of different medications can vary greatly with each plan," Fults says.

It may be worth your time to set up a spreadsheet with your medications and the costs under your different Medicare Advantage and Original Medicare options.

If you take a number of prescriptions, you may reach a coverage gap known as the "donut hole." This is an annual limit on what the Advantage or drug plan will cover for drugs. The Affordable Care Act set a schedule to close the donut hole by the year 2020, so next year's hole will be smaller than this year's gap.

The donut hole is between $3,820 to $5,100 on covered medications. Starting at $3,800, Part D enrollees get a 75 percent donut hole discount on brand-name drugs. You get up an up to 37 percent donut hole charge on generic drugs. 

Consider the plan's maximum out-of-pocket costs. You may want a plan that has a low out-of-pocket maximum "so you'll be protected should you have something going on with your health," McIntire says. If you're healthy and don't plan to use much health care, you might want to risk a higher out-of-pocket maximum.

Ways to buy a Medicare Advantage plan

Use Medicare's Plan Finder.

Visit the plan's website to see if you can sign up online.

Enroll by filling out paperwork. Contact the plan to get an enrollment form. All Medicare Advantage plans must offer this option.

Call the plan directly: 1-800-MEDICARE (1-800-633-4227).

You can't buy Original Medicare or Medicare Advantage plans on state health insurance exchanges. The exchanges sell only individual and family health insuranceo.

A good resource for choosing the best Medicare Advantage Plan is the plan finder tool on Medicare.gov. After you determine what Medicare Advantage plans are in your area and appear to meet your needs, go to the plan's website to double check and suits your needs.

You also can call the plan and talk to a plan representative. If you speak with a representative to confirm that the plan you want covers all your drugs and that the doctors, hospitals and pharmacies you want to use are in its network, take notes. Keep a record of whom you spoke with and what was said.

The bottom line: Cost in the long run

No one can predict what healthcare you may need, but based on your claims this year you can look for the plan that has the best coverage and costs for you.

If you choose a Medicare Advantage plan and find you're unhappy with it, you may have an out. There is an annual disenrollment period from Jan. 1 to Feb. 14. During this time, you can drop your Medicare Advantage plan and go back to Original Medicare. You can't switch Medicare Advantage plans during disenrollment, but you can buy a stand-alone prescription drug plan if you drop your Advantage plan.

If you need help with choosing a Medicare plan, visit medicare.gov, call 1-800-MEDICARE or contact your State Health Insurance Assistance Program (SHIP).

Additional reporting by Beth Orenstein

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