Pick the Best Medicare Advantage Plan for You

I’m searching for a new Medicare Advantage plan during open-enrollment period this year. Can you give me advice on choosing the best Medicare Advantage plans?

You have from November 15 to December 31 to switch to a new Medicare Advantage plan for 2011, and two new resources can help you pick the best plan. Some Medicare Advantage plans are changing significantly in 2011, so this is a good year to compare all of your options even if you’ve been happy with your current plan. For details, see Changes to the Medicare Advantage Plan.

HealthMetrix Research recently released its annual Cost Share Reports, which rank Medicare Advantage plans by city based on out-of-pocket costs (premiums, deductibles and co-payments) for plan benefits used by people in three health-status categories (good, fair and poor). The costs include physician office visits, emergency care, hospital care, preventive care and prescriptions. HealthMetrix also selects the top plan in 95 cities for the 2011 Senior Choice Gold Awards for Excellence in Medicare Benefits Value, which assesses the plans based on their plan design and cost-sharing comparisons.

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Use the improved Medicare Plan Finder tool at Medicare.gov to compare premiums, deductibles and co-payments for each of the Medicare Advantage plans available in your area (called Medicare Health Plans in this tool). See A Step-by-Step Guide to Comparing Your Medicare Options for more information about how to make the most of this tool. Because Medicare Advantage plans cover health-care as well as prescription-drug expenses, it’s important to compare these overall costs for the types of doctors’ visits, drugs and medical care you typically need, and to see how much coverage you would get for an accident or major illness.

But cost is only one issue to consider. Medicare Advantage plans often have strict rules about which doctors and hospitals are covered, what preauthorization you need before getting certain types of care, and what procedures are excluded, so it’s a good idea to study the coverage details and customer-service ratings before picking a plan. Saving a few dollars in premiums can backfire if you end up with a plan that hassles you about claims or puts a lot of restrictions on your coverage. A useful new resource was just added to the Plan Finder tool that can help you compare the plans’ customer service ratings and complaint records.

The Plan Finder tool includes each plan’s overall rating based on 36 topics within five categories: staying healthy (screening, tests and vaccines), managing chronic conditions, health plan responsiveness and care, and health plan member complaints and appeal (those last two categories are particularly important). For plans that also cover drug services, the tool includes an additional 17 topics in four categories -- drug plan customer service, drug plan member complaints and Medicare audit findings, member experience with the drug plan, and drug pricing and patient safety. There’s also a red caution sign for plans that have received a low rating from the Medicare program for three years in a row.

You can get more information about the ratings in each category if you click “compare plans,” then click on the “plan ratings” tab. Look most carefully at “ratings of health plan responsiveness and care,” which measures ease of getting care and seeing specialists, customer service, and overall rating of health care quality. Also focus on “health plan member complaints and appeals,” which rates how many complaints Medicare has received about the health plan, whether the health plan makes timely decisions about appeals, and how often an independent reviewer agrees with the plan’s decision to deny a member’s appeal.

For more information about Medicare open-enrollment options, as well as options for Medicare Advantage, Part D prescription-drug coverage and medigap plans for 2011, see Update Your Medicare Game Plan.