Medicare Advantage plans can be attractive because of the low or $0 monthly premiums insurers charge. Like anything in life, there are trade offs and sacrifices we all have to make. When it comes to Medicare Advantage plans, the trade offs are usually less freedom when it comes to which doctors and hospitals you can use as well as more restrictions or red tape when it comes to getting services covered. In order to choose a Medicare Advantage plan wisely, I’ve come up with an easy guideline to follow. Following these steps should hopefully ease the potential frustrations within Medicare Advantage.
First, it helps to gather the information specific to this decision. Medicare Advantage plans should cover your doctors, hospitals, and prescriptions. On a piece of paper, write down the names of your current doctors, preferred hospital, and prescriptions.
Next, call each doctor to find out which Medicare Advantage plans they accept or have the best success with and write that down. You could say, “I am calling to find out which Medicare Advantage Plans Dr. Smith participates in.” They should be able to give you the names of different plans available. In some cases, your doctor may not accept ANY Medicare Advantage plans. If changing your providers is a deal breaker, you can stop your search now because you will need to stay with Original Medicare in order to see those doctors.
After you have all of this information written down, you should hopefully see some overlap with your doctors. For example, lets say that all of your current doctors accept Anthem Medicare Preferred Core (PPO) and Gold Advantage Option 1 (HMO). You have now successfully narrowed down your search to 2 options instead of the 50 available Medicare Advantage plans that operate in St. Louis County. This is a much more manageable number!
Next, contact your preferred hospital and ask them if they accept the 2 plans that your doctors accept. Let’s assume that both plans are accepted by St. Luke’s Hospital in Chesterfield, MO.
Finally, each company has a different formulary or list of drugs they cover. Each company will also have a different co pay depending on the tier. You should compare the drugs you are taking and see which tier they are on. Many times the same drug is covered on a different tier, resulting in a higher cost with one company over another.
In our example, our person is taking 2 drugs, Crestor for high cholesterol and Nexium for acid reflux (GERD). When we look at Gold Advantage and Blue Cross’s formularies, we find that both Crestor and Nexium are Tier 2 on Gold Advantage and Tier 3 on Blue Cross. This means that our monthly drug costs is $60 for Gold Advantage or $140 for Blue Cross.
| Tier 1 | Generic | $4 co pay |
| Tier 2 | Brand Name | $30 co pay |
| Tier 3 | Non preferred Brand Name | $70 co pay |
Using this strategy allows you to pick a plan that has all of your doctors and preferred hospital in-network and the lowest cost on your prescriptions. This should help minimize the frustration by allowing you to keep the providers you are comfortable with, have your preferred hospital, and keeping even more money in your pocket by finding the lowest co pay on your drugs.
Have you had success picking a Medicare Advantage plans using these tips and stratgies? If so, leave additional advice in the comments section below or on our facebook page.
Good luck!
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