Sunday, August 19, 2018
News Roundup

Medicare 2016: What to look for in a plan

You've used Medicare's online Plan Finder to determine which prescription drug and health plans are available. Now comes the hard part: deciding which one is best for you. There's a lot to consider, and it goes far beyond premiums and deductibles. Is the plan reliable? Will it cover your medications? Are your preferred hospitals and doctors part of the network? Before you make a choice, here are the three pages on the Plan Finder site you may want to examine:

The Plan Results page

• Estimated Annual Drug Costs: The first column on the list. This is based on your premium and the drug costs at the two retail pharmacies you selected.

• All Your Drugs on Formulary: Found in the fourth column on the Plan Results page. If you see "No'' listed for any of your drugs, that is a sign that you might be able to reduce the cost of this plan by switching to a different brand-name drug or generic. Go further down in this column and click on the blue link that says "Lower Your Drug Costs." On the next page, click on blue links that say "Calculate savings.'' They will show you how much you can save in a year by switching to a different drug on this plan. Return to the Plan Results page and check any other plans that interest you.

• Overall star rating: Second column from the right. Medicare grades all plans on a five-star scale, based on customer satisfaction and various health outcome measures. For details of each plan's evaluation, click on the plan name and then the green Star Ratings header on the next page. Then return to the Plan Results page.

Tip: Plans that have performed badly for three years will be marked with a warning sign, which can be important. In previous years, some plans that received warnings ended up folding midyear.

• Icons for health plans: If plans offer coverage for vision, dental or hearing, colorful icons will be placed in the Health Plan Benefits column.

Tip: Take these with a grain of salt until you do more research because these services may be covered but that coverage may be puny.

The Health Plan Benefits page

This is for Medicare Advantage plans only. You find this page by clicking on the name of any plan on the Plan Results page. Then look for the green header that says Health Plan Benefits. This page has detailed information about copayments and deductibles for different services. For instance, if you require frequent visits to a specialist, plans with low specialist copayments may save you money. Hospital deductibles and copayments can be very important if you are planning surgery next year.

Another important entry is the Out-of-Pocket Enrollee Responsibility, about halfway down the Health Plan Benefits page. After your copayments and deductibles hit this limit in a given year, you pay nothing more for covered services. If other factors are equal, plans with low out-of-pocket spending limits are usually better.

Tip: These limits do not apply to your prescription drug costs. People are still responsible for their copayments, no matter how high.

Another tip: For Medicare HMOs, the spending cap applies only for services received inside the network. Outside the network, your potential costs are unlimited. Some PPO health plans have out-of-network spending caps as well. In some instances, this can be a great benefit. (For instance, if you get cancer and want to go to a clinic or specialist of your choice, an out-of-pocket spending limit will cap that cost.)

The Drug Costs & Coverage page

Again, click on the plan name on the Plan Results page, and then the green header about drug costs and coverage. You can see how your costs will vary between the two pharmacies you selected. You can see how mail order will alter the costs. You can explore switching one drug for another and see how costs change.

Down toward the bottom is a small link that displays preferred pharmacies in the network. Click on it and you will see a map that gives you wider pharmacy options than just the two you originally selected.

Once you have done this research, return to Step 12 and pick a plan.

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