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Find the Best Medicare Plan

Oct. 26, 2012
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It’s decision time again for this country’s approximately fifty million Medicare recipients. Which plan has the lowest premiums for 2013? Who’s got the drugs I need? Who provides them the most cheaply?

Providers have made their commitments for the coming year, and now it’s up to us to shop around for the best deal – or sit back, do nothing, spend another twelve months with the plan that’s served us well up to now. Open enrollment started on October 15, and we have until December 7 to make up our minds. Our decisions take effect on January 1; if we get cold feet before February 14 we can back out of our Medicare Advantage plan into plain-vanilla, fee-for-service Medicare for the coming year if necessary.

As usual, there are lots of options, and they vary depending upon where you live. Some people find it easiest to hire a counselor to make sense of the confusion. Colleen King, an insurance agent and adviser in Southern California, notes that: “In most of Los Angeles County there are 24 Medicare Advantage plans (mostly Medicare HMO’s) and 32 Part D drug plans to choose from.” Nearby Ventura County offers the same number of drug plans, but only four or five Medicare HMO’s. Travel a lot? A Medicare Supplement (Medigap) program might suit your lifestyle better than an HMO, since you can go to a Medicare doctor wherever you find yourself needing one.

According to Harriet Hoffman, a Medicare and Social Security consultant in New York, folks change plans for a bewildering variety of reasons. “People may switch from a [private] Medicare Advantage plan to a Supplement Plan [based on original Medicare] if they have a change in health status, or switch from a Supplement Plan to an Advantage plan for financial reasons,” she explains. “Sometimes they are following a medical provider who is dis-enrolling from their Advantage plan but is enrolled in another plan.”

Fortunately, plenty of help is available, and some of the best is free.

Regardless of what state or U.S. territory you’re in, you can use the State Health Insurance Assistance Program (SHIP) to contact a counselor in your area who can explain the intricacies of the various Medicare plans, options, co-pays and deductibles available to you. There’s no charge for this service, or for counseling over the phone from the Medicare Rights Center, at (800) 333-4114.

Probably your most valuable resource is the Medicare Plan Finder, which is provided by the government itself. You plug in a few pieces of relevant data online, and Medicare lists your local options. They even rank them for you, by cost and effectiveness. HMO’s that receive Medicare’s coveted five-star rating (such as Kaiser Permanente in the San Francisco Bay Area) are worth a special look if you happen to live nearby.

You’ll need your Medicare number to kick off the Finder’s personalized search, but you can also do a standard one with only a ZIP code. Either way, be sure to have a detailed list of your medications on hand so Finder can make valid comparisons of different plans’ benefits. In my case, I only needed to enter the first character or two of my drugs’ names; since the site already had my ZIP code and the name of my HMO, the application was able to fill in the names of the medications, with my particular dosages and frequencies. That was a surprise, but it doesn’t feel quite so intrusive when you know that Big Brother is there to give you some advice! He even notified me that I might qualify for the Extra Help program to help with my prescription-drug costs.


Health care image via Shutterstock.