Medicare Insurance AZ staff answers:

Check to see if there are any $0 premium Medicare Advantage plans or plans with a lower premium in your area. You have until March 31 (Open Enrollment Period) to change to a “like” plan.

Medicare has very strict regulations. If your current plan has drug coverage you can switch to another plan that has drug coverage during OEP. You can switch to a Medicare Advantage PFFS plan without drug coverage and pick up a stand alone drug plan. You can purchase a stand alone drug plan, which will automatically cancel the Advantage plan and will put on original Medicare.

You cannot change to a Medicare Advantage PPO or HMO without drug coverage during this period and you cannot just drop your Medicare Advantage plan.

If you are also on Medicaid the regulations differ.

Medicare Insurance AZ staff answers:

Take a look at HealthNet’s new “fee-for-service” plan and how it hooks up with Medicare Part D. Currently, I think it’s one of the better designed plans out there.

Medicare Insurance AZ staff answers:

First an explanation of drug coverage. These figures are for 2009 and will change next year.

Medicare set up drug coverage as follows. First a $295 deductible, which most plan do away with. Then you are in “initial coverage” where you pay ~25% of the drug costs. Most plans will have a set co-pay instead of a percentage but it averages out to ~25%. Then you go into the coverage gap or “donut hole” where you pay 100% of the drug cost. You will not pay retail but will pay the negotiated cost that the insurance company has with the pharmaceutical company. This will vary by medication and company. After you’ve paid out a total of $4350 out of pocket you then go into “catastrophic coverage” where you pay ~5% of the cost. Again, most companies have a set co-pay. The companies have set up tier levels for the medications. Generally, there are 4 tier levels but some companies can have 5 or 6; your cost will be lower if a medication is in a lower tier. Any particular medication could be in a different tier level with a different company.

There is no one best overall Medicare Advantage plan. Drug costs will vary widely by plan depending upon what medications you are taking. You will need to analyze what you are taking with each company or find an agent that can do it for you. One example: I have a client and I did a cost analysis of his medications. The total monthly cost for his meds (that he and the insurance company paid) with the 15 least costly plans available to him ranged from $3182 to $4910 (needless to say he went into the donut hole). More than 15 plans were available but I did not keep a record the higher cost plans. His actual total ANNUAL cost for those top 15 plans ranged from $3299 to $7121, which is a big difference. The point is, most of the plans that usually and regularly come in cheaper were in the $6000 – $7000 range.

Medicare Insurance AZ staff answers:

All Medicare Advantage plans must follow the template put forth by Medicare so their claims are valid.

The downsides are:

-You have co-pays for Medical procedures which can add up.
-Some types have doctor network and all have restrictions to which doctors you can see.
-Not all doctors accepting Medicare will accept the Advantage plans.
-With some plans, such as the PFFS plans, doctors can choose not to accept it at any time, even if they just saw you yesterday and accepted the plan at that time.
-They may only have emergency and urgent care services available if you are in a different state so if you spend a lot of time away from home you may run into trouble getting care for minor ailments.
-They change every year so you need to check every year to make sure the plan you have is still the best one for you.
-They are funded primarily by Medicare so as Medicare cuts back costs in response to the health care bill your co-pays will increase. Also, many plans that have a $0 premium now will probably have to start charging a premium.
-There is a lot of confusion to the different types. Depending upon your area there are HMO, PPO, PFFS, SNP, MSA, DUAL, COST, and PACE plans available.
-The plans are county specific so if you move out of the service area you’ll need to get another plan.
-They are subject to Medicare “lock-in” which means you can only change plans once per year.

The upsides are:

-The premium is low or even $0 for many plans so it is much cheaper than a Medicare Supplement.
-Most plans include drug coverage.
-If your doctor accepts the plan or you do little traveling they can be very cost effective.
-Skilled nursing facility stays are not subject to the three day hospital stay requirement.
-Thay have additional benefits, such as an annual physical.
-Some have dental, vision and hearing benefits.
-There are no pre-existing limitations except if you have ESRD.

In summary, a Medicare Advantage plan will generally be better for you that just Medicare. Whether it’s better or worse than a Medicare Supplement depends upon your particular situation. I’d recommend visiting a local agent that works with all the major companies in your area and offers both Medicare Advantage plans and Medicare Supplements. The agent can explain how each plan works and find the best plan for you. There is no extra charge using an agent and you’ll have someone local should you have questions or problems in the future.

Medicare Insurance AZ staff answers:

It’s going to vary wildly by state.