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Using your computer to find the right Medicare Advantage plan

Sometime later this year, Medicare Advantage plans will pass employer retiree plans as the most widely held type of Medicare insurance. Currently there are 20 million people in Advantage plans, more than twice the number ten years ago.

While total Medicare enrollment has grown at slightly more than 3% a year during the last decade, Advantage plan enrollment has increased twice as fast.

To keep pace with the influx of new enrollees, insurance companies have been rolling out additional Advantage plans. There are 283 more this year than last year, or a total of 2,317 plans, according to a report by the Kaiser Family Foundation.

That’s the most since 2009, when generous government subsidies encouraged insurers to flood the market with plans.

This year’s expansion has a potential upside. As the newer Advantage plans vie for market share, they need to offer attractive benefit packages. And that might put pressure on older plans to follow suit.

The downside is that even before this year’s additions, in most parts of the country there were already too many Advantage plans. Retirees often complain in surveys that they are overwhelmed by having so many choices. This year, for instance, the average Medicare beneficiary can choose among 21 Advantage plans, according to Kaiser Family Foundation data.

How do you sort through so many plans to identify the one that’s best for you? If you live in an urban area, your chances of finding an excellent plan are good. But if you live in the country, that may not be the case. This year there are 149 counties that do not have any Advantage plans and another 45 counties with only one plan. And more than one-fourth of U. S. counties have five or fewer plans.

Even if you live in a remote outpost where there’s only one Advantage plan, you need to do some homework to avoid unpleasant surprises later. If you are computer savvy, you can easily find out quite a bit about a plan online. Or if you don’t want to do the research yourself, you can contact your nearest Medicare counseling agency for assistance.

To do your own research, you’ll use the Medicare web site’s Plan Finder. There you can rank your area’s Advantage plans in various ways – by monthly premiums, costs for the prescription drugs you take, quality ratings, and so on. And by clicking on a plan’s name, you can see its benefits in greater detail. Here are the steps to follow:

First, rank the plans by their costs for the Rx drugs you take

Using Medicare’s Plan Finder and these step-by-step instructions, enter the names, dosages, and monthly quantities of the drugs that you take. If you do not take any prescription drugs, skip the drug entry and go directly to a list of the Advantage plans in your area. Then you can begin the sorting process.

Let’s say you live in Atlanta, Georgia, and do not take any prescription drugs. When you sort the list of the 21 Advantage plans in the Atlanta area by their drug premiums, you see that 8 of them have annual premiums exceeding $400. That is too much to pay if you do not take any Rx drugs, and so you disregard these 8 plans and concentrate on the remaining 13.

Within a couple of minutes, you can probably trim the remaining list down to 2 or 3 plans based on what you want in a plan. Possibly one of your doctors told you she is not in any Advantage plan networks. That leaves as your only choice an Advantage PPO plan. And among the 13 remaining Atlanta-area Advantage plans on your list, only two are PPO’s.

Or maybe you want to consider only the plans that have at least a four-star quality rating from Medicare. In that case, only 4 of the 13 plans meet that standard. Perhaps you want a plan that has an out-of-pocket under $5,000, which will eliminate all but 3 plans.

Examining the networks

After you’ve weeded out most of the plans, the next step is to find out if your doctors are in the networks of the plans that are still on your list. Because the online provider directories for Advantage plans are often out of date, the most accurate way is to call your doctors’ offices. And if your doctors are in the network of only one of your finalists, it is likely to be your best option.

There’s a chance, of course, that none of your doctors are in the networks of the Advantage plans that have low costs for your drugs. Last year in a Kaiser Family Foundation study of 391 Advantage plan networks in 20 counties around the country, the authors found that 46% of the county’s physicians were in the average plan’s network.

Yet many HMO plan networks had fewer than 30% of the physicians in a county. These so-called narrow-network plans had the lowest premiums — $720 a year lower than the plans that included 70% or more of a county’s physicians on their rosters. The authors concluded that a plan’s premiums are often a good indication of the size of its network. To get access to more doctors, you may need to enroll in a plan that has higher premiums.

Before deciding to enroll in a PPO, make sure you look at the costs for seeing provider who is not in the network. Frequently Advantage PPO plans will charge you 40% or 50% of the cost when you go outside the network.

Sometimes it makes financial sense to enroll in a PPO plan even though more than one of your doctors are not in the plan’s network. But your risk is less if they are doctors you do not see regularly or for expensive treatments. Admittedly, though, it may not be possible to predict whether you will need costly treatments. And it may not be wise to enroll in a PPO when your primary care doctor – the physician you are likely to see most often – is not in the network.

Taking a plan’s quality rating into account

Today’s Advantage plans provide better medical care than they did just a few years ago. That’s because Medicare awards them generous bonuses when they earn a quality rating of four stars or higher. And because these bonuses are so sizable –UnitedHealthcare received $1.4 billion in quality bonuses in 2016 – plans work hard to get good scores.

The more than 40 quality measures that Medicare tracks include ones for customer satisfaction. A high rating may indicate that, among other things, people who are already enrolled in the plan believe that it provides good care.

Each year Medicare changes a few quality measures to keep plans from ignoring the things that are rarely measured. Also, the threshold for getting a high rating may be raised from one year to the next. To earn quality bonuses, then, plans must score well on most of the measures, including some that may change from one year to the next, while also improving their overall performance. ◊◊

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