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Identifying the Medicare Advantage plans that meet your needs

Medicare Advantage plans are usually the lowest-cost option for people who don’t have employer supplemental coverage. In 2013 more than one-half of the people enrolled in Advantage plans have no premiums for their medical and drug coverage. Their only costs will be for co-payments, co-insurance and in some cases deductibles. Also, preventive tests and screenings are covered 100% by Medicare. If someone is in good health, uses relatively few medical services and does not take expensive drugs, his or her costs should be low.

When someone enrolls in an Advantage plan, the plan replaces Medicare’s coverage for as long as he or she is enrolled in that plan. Medicare pays Advantage plans a certain amount for each enrollee, and the rules require that the plans cover the same benefits that traditional Medicare does. But plans can have different cost-sharing than Medicare’s, as long as their overall benefits are as good. In addition, some plans cover services such as routine dental and vision care that Medicare does not cover.

More than one-half of Advantage plans are HMO’s, where the coverage is for services provided by the plan’s networks. Before seeing specialists, patients usually must get referrals from their primary care physicians (emergencies are exceptions). Other types of Advantage plans include Preferred Provider Organizations (PPO’s), Private Fee-for-Service (PFFS) plans, Special Needs Plans, and Medicare cost plans.

Advantage chart

Most Advantage plans include prescription drug coverage. When people enroll in Advantage plans that include drug coverage, they need to make sure that the plans do not have high costs for the prescriptions they take.

Before you enroll in an Advantage plan, you should know the answers to the following questions:

  • are your doctors in the plan’s network?
  • does the plan have an adequate provider network?
  • does the plan have low costs for the prescription drugs that you take?
  • does the plan have a low out-of-pocket limit?
  • does the plan have good quality ratings by Medicare?

Using Medicare's Plan Finder to Compare Advantage Plans

This file has step-by-step instructions for using the Medicare web site to find the Advantage plans that are available in your zip code. If you want to see Advantage plans’ costs for the prescription drugs you take, do not use these instructions. Instead, follow the instructions under “Using Medicare’s Prescription Drug Plan Finder” on the Part D Plans web page.


Managing Medicare’s Costs

  • Finding ways to save money on Medigap policies (2 of 2)

    Medigap policies are the easiest-to-understand type of Medicare supplemental coverage. That’s because they almost never change their benefits. Six of the ten Medigap plans have the same benefit designs that they had 25 years ago — other than for a few tweaks that resulted from changes in Medicare’s benefits. And the coverage of the other four Medigap plans has not changed since they first came on the market in 2010.

    While their coverage is easy to understand, Medigap policies’ pricing is confusing. Here’s an example: if you are a 65-year-old San Francisco resident enrolling in Medigap Plan N, for instance, you may pay as little as $1,117 a year or as much as $1,807 a year, according to quotes from CSG Actuarial.

    Thus if you buy your policy from the most expensive insurer, you’ll pay 62% more than if you choose the least expensive company – even though the coverage is identical.

    Why do premiums vary so much? One answer is that insurance companies know that some retirees do not shop around before buying a policy. A handful of insurers may intentionally overprice their Medigap policies because they are willing to sell fewer policies so long as the ones they do sell have hefty profit margins.

    Another reason is that smaller, less well-known companies may have to offer larger commissions to entice insurance agents to sell their policies, and that added cost is reflected in steeper premiums. Still another reason is that when insurance companies are losing money on their Medigap policies, perhaps because of past underwriting errors, they have no choice but to hike premiums.

    Companies use one of three different rating methods when they set premiums. The most common one is the attained-age rating, which raises your premiums by about 3% for each additional year of age in addition to an annual increase to account for for health care inflation. Attained-age policies are usually the best deals for young retirees but can be pricey for older people.

    The issue-age rating method, on the other hand, raises premiums to stay even with medical inflation but does not adjust them for age except when the policy is initially sold. Issue-age policies usually have higher premiums for younger retirees since future age increases have already been priced in. But issue age-policies should be less expensive for older retirees who purchased their policies years earlier. Six states require insurance companies to use issue-age ratings – Arizona, Florida, Georgia, and Idaho. Missouri, and New Hampshire.

    The third method uses a community rating approach in which everyone pays the same premiums regardless of age or health. Like the issue-age approach, community ratings result in premiums that are expensive for younger retirees but relatively affordable for older people. The popular UnitedHealthcare (UHC) policies endorsed by AARP use a modified community rating in most states, although they will sometimes set their premiums higher or deny coverage to people who want to acquire a Medigap policy after their initial enrollment period has passed.

    So that their premiums will be competitively priced for younger retirees, UHC modifies its community rating by offering discounts of 3% a year for each year that the policyholder is younger than 75. This results in a 65-year-old getting a 30% discount, a 66-year-old a 27% discount, and so on until at age 75 the discount has vanished. Eight states require Medigap policies to be community-rated – Arkansas, Connecticut, Maine, Massachusetts, Minnesota, New York, Vermont, and Washington.

    In trying to protect yourself from sharp increases in premiums, it can helpful to know which ratings method an insurer uses. As an example, if you find an issue-rated policy that has lower premiums than an attained-age policy, it is expected to have lower premium increases over the long term than will the attained-age policy.

    But there are other factors which also play key roles in future premium increases. Companies that have conservative underwriting rules and low sales costs will have lower premium increases regardless of which ratings method they use. And state insurance regulators also play a role. The Florida Office of Insurance Regulation, for example, places caps on Medigap policies’ yearly premium increases.

    Here are suggestions about ways you may be able to save money when you are buying a Medigap policy:

    Compare premiums from at least three insurance companies. But which three companies do you call, since in many states 30 or more insurance companies sell Medigap policies? As a start, you can look at your state insurance department’s online premium comparisons for Medigap policies, which can be found at the bottom of this page.

    Most states list each company’s premiums for individuals of various ages (age 65, age 70, etc.) as well as its toll-free number. Even though some states do not regularly update their premium comparisons, they will give you an idea of the companies most likely to have lower premiums.

    The objective is not necessarily to buy your policy from the company that has the lowest premiums, but to buy from a company that has reasonably low premiums and that meets your other criteria, e.g., it is a large, well-known insurer.

    If you live in one of the few states that do not have the online comparisons, you can go to the Medicare web site to find a list of companies selling Medigap policies in your state. you might use the Medicare web site’s list of companies here. The Medicare web site does not show insurance companies’ premiums but it does list their toll-free numbers.

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