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How to Compare Medicare Advantage Plans

Follow this step-by-step guide for using Medicare's Plan Finder tool to search for the best all-in-one medical and drug coverage.

What should I look for when comparing Medicare Advantage plans during open-enrollment season this year? Can you suggest some resources to help?

The best tool for comparing Medicare Advantage plans, all-in-one private plans that provide medical and well as drug benefits, is the Plan Finder tool at Medicare.gov.

Start at the Plan Finder main page, where you can personalize your search by entering your Medicare number (you can also do a general search for your zip code). Answer some questions about the type of Medicare plan you have now (note that the Medicare Advantage plans are called “Medicare Health Plans” in this tool), then click on the name of your plan. After that you enter your medications and dosages, as well as select local pharmacies (or just click “I don’t want to add pharmacies now”).

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You’ll see a summary page listing the number of Part D prescription-drug plans in your area, the number of Medicare Health Plans with drug coverage, and the number of Medicare Health Plans without drug coverage. You’re given several options on the left side to refine your search, such as capping your monthly premium, but it’s generally best to keep the search more general at this point. If you have health issues, however, change the health status from the default “good” to “poor” to adjust the tool’s estimates of your out-of-pocket costs.

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Click on “Medicare Health Plans” to see the Medicare Advantage plans available in your area. Focus on the Estimated Annual Health and Drug Costs column (the sixth column), which shows your expected out-of-pocket costs for premiums, co-payments and other expenses for drugs and medical care, based on average health status for Medicare beneficiaries (or for people with poor health, if you changed the status in the refine search tool).

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These expense estimates are based on averages, not your personal health care needs, so it’s important to study the plans’ coverage details. You can read about the basic deductibles, co-payments for each tier of drugs, out-of-pocket spending limits and any drug-coverage restrictions for each plan on the main grid. If you want more details, check the plans you’re interested in, then click “compare plans.”

Select “Health Plan Benefits” to see more information about the co-payments for in-network and out-of-network doctor-office visits, specialist-office visits, outpatient hospital services, emergency care, inpatient hospital care and several other categories for the plans you highlighted.

Because the cost can be higher for out-of-network services, make sure your favorite doctors and hospitals are included, and find out about any preauthorization rules. If you’re thinking about keeping your current plan, make sure your doctor will stay on.

Customer service can make a significant difference for Medicare Advantage plans, so it’s important to look at Medicare.gov’s star ratings for each plan (the fourth tab). This feature assesses the plans in several categories, such as health plan responsiveness and care, member complaints, appeals, drug-plan customer service, and managing chronic conditions.

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In addition to Medicare.gov’s Plan Finder, you can get information about the Medicare Advantage plans available in your area from the “Cost Share Report” available free at MedicareNewswatch.com, an annual analysis published by HealthMetrix Research. The service chooses the Medicare Advantage plans with the best overall value in 85 cities, based on estimated out-of-pocket costs for three levels of health status (healthy, episodic, chronic) and utilization of the most common health plan benefits (such as physician office visits, emergency care, hospital care, home health visits, preventive care and prescriptions).

If you’d like personalized help with your search, contact your State Health Insurance Assistance Program (SHIP). See How to Compare Medicare Policies for more information.

Remember, you’ll need to make your open-enrollment decisions earlier this year -- you have from October 15 to December 7, 2011, to sign up for your 2012 plan. See New Deadlines for Medicare Choices for details.

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