It’s that time of year again.
Piles of Medicare related mail, and ever growing confusion.
But according to CMS.gov, Medicare Advantage Premiums remain stable, and enrollment is at an all time high.
Medicare Advantage is likely here to stay.
It’s easier than you might think to find the best plan for you.
You don’t need to be an insurance whiz, or the most computer savvy, to find the best Medicare Advantage plan.
They key is knowing where to look.
In this article I’m going to show you how to find the best plan for your situation (no matter where you live in the U.S.), without giving away personal information or getting harassed by agents.
We’ll look at
- What you will need before you start
- How the process works
- Options if you don’t want to do it yourself.
Don’t let procrastination or fear cost you!
You can get help.
Use Medicare.gov for comprehensive Medicare Advantage plan search
Whether you are new to medicare, on a Medigap plan and just curious, or tired of the rising costs of your existing plan: this is the fastest way to know for sure what’s available.
Use Medicare.gov for all medicare plan searches.
You will never have to give personal information.
You won’t get 20 calls within the hour of performing this easy search.
Do it yourself Medicare Advantage search
Start with Medicare.gov to get an overview of EVERY available plan in your zip code.
(Need a drug plan only? Go to this article about how to find the best drug plan on Medicare.gov).
Gather the following before you begin:
- Complete list of medications (dosages, quantity, and brand or generic status)
- Doctor and hospital preferences
- List what is important to you from most to least (i.e. 1st) lowest doctor copay, 2nd) no deductible 3rd) low inpatient hospital cost etc…)
Before you do anything
If you want to keep your current doctor(s):
I highly recommend calling your doctor and asking the office staff or billing specialist:
“What Medicare Advantage plans are accepted”?
The individual you speak with may not be familiar with this terminology.
Just the other day, I spoke to a doctor’s staff member that said,
Oh, we take all medicare plans.
This is usually true in the case of Medigap, but NOT Medicare Advantage.
Be sure to clarify:
“I’m speaking about the Medicare Advantage program, usually an HMO (sometimes a PPO).”
People that work in doctor offices are sometimes confused about how Medicare works, and sometimes get confused about the differences between Medicare Supplements and Medicare Advantage.
Medicare Advantage plans have strict network limitations, so you must be sure to get the correct information.
Calling and talking to your doctor’s office staff is just a preliminary quick check.
First, it saves you time because your doctor may not accept these plan types at all.
(If that is the case, you must decide between healthcare costs and freedom to choose your providers).
Secondly, if your doctor gives you a list of accepted Medicare Advantage plans, that gives you a place to start and makes your search easier.
I cannot stress enough that a doctor’s staff member mentioning a Medicare Advantage Plan is not a guarantee the doctor is in-network.
After your Medicare.gov plan search, you must visit each plan’s online provider tool to ensure participation in the network.
Medicare.gov Plan Search Tool: Step-By-Step
Go to Medicare.gov. The top part of the page will look like this:
Click on “find health and drug plans.”
Next, enter the zip code of your physical residence, and click “find plans.”
You may answer the questions seen below as “I don’t know” to get through the tool quicker. Click “continue to plan results.”
Next, if you don’t take medications, click “I don’t take any drugs”
if you take medications, begin entering your drugs.
Save your drug list ID if you have a long list! This will save time each time you search, or if you experience a power outage or computer crash.
Next up – choose a pharmacy (or two). Widen the distance (mileage) radius to see more pharmacy choices.
Next, refine plan results: choose “Medicare Health Plans with drug coverage” (you can choose plans without drug coverage here also).
Notice, in the sidebar there are options to really narrow down your search. More about that in a minute.
Then click “continue to plan results.”
The tool will list every Medicare Advantage plan listed in your zip code (not including special needs plans like chronic health or Medicaid plans, unless you chose these plan types in the optional filter.)
About the Optional Plan Filter
I have mixed feelings about the filter. I like to see the big picture first. I want to see all plans in a zip code, and how they rank based on overall cost.
However, if certain criteria are non-negotiable to you, choosing certain filters will help narrow down your options.
The plan filter will also reduce overwhelm.
Keep it simple s*****!
I already mentioned calling your doctor to ask what Medicare Advantage companies they are contracted with (if any).
Now that you have a list in front of you, of all available plans in your zip code, find the carriers your doctor accepts.
Choose up to three plans (your doctor accepts), and do a side-by-side comparison.
If you don’t have a doctor, or are open to switching, continue with the following instructions:
- Once you’ve pulled up the list of plans, look at 3-4 main criteria.
- Sort with the drop down menu, according to Lowest Estimated Annual Health and Drug Cost, This gives you a starting point of lowest overall cost, to highest overall cost (estimated).
- Also take note of the Estimated Annual Drug Costs in the left hand column, especially if you have entered a drug list into the search tool.
- Next, look at premium, deductible amount (if any), and out of pocket spending limit.
- Check the little boxes to the left of the three plans that fit these criteria.
- Next, look at the summary under the Health Benefits tab.
Some important copays to compare:
- Primary doctor visit
- Specialist visit
- Urgent care
- Outpatient surgery
- Inpatient hospital
- Labs and radiology
- Skilled nursing
At this point, 1-2 plans will really stand out as a winner.
However, if drug cost is a huge factor, you should search plans first based on lowest annual estimated drug costs first.
Of the top three plans you’re comparing side-by-side based on DRUG COST, the next step would be to match one of these plans with providers that will work for you.
Once you find a plan that accepts your doctor, make sure the specialists you prefer are accepted also.
If you don’t have a preferred doctor, simply choose the preferred plan based on your medications and preferred copays. Then go to the plan site and access the provider finder and choose from available doctors in the directory.
Recommendations to narrow down your doctor choice
When switching plans to save money, sometimes you must switch healthcare providers also.
Online reviews can be one way to narrow your search. Another good method is to ask a specialist that you trust, to recommend a primary care doctor.
Sometimes you can find a doctor by asking friends and neighbors.
I also suggest you call the physician’s office to find out:
-Does the office staff answer the phone?
-Are they easy to understand and patient with questions?
-Is the doctor accepting new patients?
-Stop by for a visit to make sure the offices are clean and efficient.
Getting help with your Medicare Advantage plan search
What if you just don’t want to do it yourself?
Where to get help:
1.) Senior Centers
I conducted a local google search in the Tampa, FL areas for senior centers, and help choosing a Medicare Plan. I did not find as many options as I hoped, through a simple google search. A better strategy might be to call your local senior center, and ask if there are any classes pertaining to Medicare help during Open Enrollment.
I have spoken to a number of folks in Kansas that mentioned local senior centers offering help with choosing and enrolling in Medicare Advantage and Part D plans.
It may be hit or miss, but there is likely to be a nearby senior center that provides some help.
2.) Local SHIP program
SHIP stands for State Health Insurance Assistance Program. Search for your State’s SHIP contact information.
According to Medicare.gov:
SHIPs offer local, personalized counseling and assistance to people with Medicare and their families.
SHIPs can help you with things like:
Your Medicare questions, including your benefits, coverage, premiums, deductibles, and coinsurance,
Complaints and appeals, and Joining or leaving a Medicare Advantage Plan (like an HMO or PPO),
any other Medicare health plan, or Medicare Prescription Drug Plan (Part D)
3.) Your agent.
You may already have access to an agent that enrolled you in your current plan. Or, maybe a local agent mailed you information, or a friend or neighbor uses an agent they trust.
Using an agent is highly beneficial if you can find the right one. An independent agent that has been working with Medicare Plans for many years is likely very knowledgeable and unbiased. Independent agents work with many carriers and are more likely to help you find a plan that fits your needs, rather than sway you to one carrier or plan.
Some agents get in the business to make a quick buck, and are soon gone when faced with difficulties. Ask around, and you may find some agents through friends that have been in the business for years and intend to stay for the long haul. It is nice to have an advocate you know, that you can call year after year. This is becoming more important each year with increases changes to Medicare.
The Kaiser Family Foundation compiled a report of first-hand accounts of seniors’ decision making strategies for choosing and changing Medicare private plans, based on 9 focus groups of 6 to 8 seniors in 4 cities.
They found that for many seniors on Medicare, the process of finding a plan is “arduous and frustrating,” and
seniors are eager to find shortcuts in making the selection with the least amount of stress and hassle, often preferring to get advice from a trusted advisor, such as an insurance agent or a plan representative.
4.) Call Medicare (1-800-633-4227)
The department of Medicare offers help over the phone, with finding and enrolling in Medicare Advantage or Part D plans.
Before calling Medicare, have a list of your medications, doctor and specialist info. (Ask yourself, are these non-negotiable? How important is it to you, to stay with these doctors?)
It may also help to think about what you do or don’t like about your current plan.
List what’s most important. List what has you angry, or what hasn’t been going well.
What do you WANT in a plan? Rank what is most important: is saving $ most important, or is freedom to see any provider most important?
5.) A trusted website or agency like us (Ally Senior Benefits)!
You can always contact a trusted online source (here’s our contact page), to get free assistance with plan comparisons like we discussed in this article.
Beware of sites that require extensive personal information, especially a phone number. Many are linked to “lead services” that capture your information in exchange for profit. This information is sold to multiple agents, and you will be bombarded with endless calls.
Opt for online agencies that are transparent – that offer location, photos of their staff, and are easy to contact. You can search any agent or agency’s legitimacy through each state’s Department of Insurance website. Look for agent or agency license numbers to perform this search.
Medicare Advantage plans are here to stay, and enrollment continues to climb.
While understanding the ins and outs of these plans is not getting any easier, there are ways to soften the burden.
For the do-it-yourselfers, there is more information than ever available online. Medicare.gov is the top trusted source for a comprehensive Medicare Advantage Plan search.
For those craving additional help, we suggested 5 options to find it.
5 ways to get help:
- Senior Centers
- State SHIP Program
- Your Agent (or a referral)
- A trusted Agency website
Most important of all: don’t let fear or procrastination cost you!