A Last-Minute Guide to Shopping for Medicare

Medicare’s annual open enrollment period is about to come to a close: Dec. 7 is your final chance to change from one Medicare Advantage or prescription drug plan to another. If you’re currently enrolled in Original Medicare, you can also switch to a private Medicare Advantage plan or drop existing Medicare Advantage coverage to return to Original Medicare.

If you’re like a lot of people, you’ve waited until the very last minute to shop your options. “We do see a lot of folks rushing at the end,” says Joe Baker, president of the Medicare Rights Center.

There are a number of reasons for that, Baker says: inertia, fear or feeling overwhelmed with too much choice. “It’s not the kind of shopping people like to do, and it’s confusing,” he says.

That’s why many experts suggest you seek help, particularly as the time left to make a choice dwindles.

“When it’s the last few days of annual enrollment and down to the wire, that’s when beneficiaries can make costly mistakes rushing to pick a plan without help and guidance,” says Joe DeLuca, director of sales at eHealthMedicare.com.

Experts say Medicare beneficiaries have lots of questions about how to find the right plan. Here, experts answer some of the most common questions asked during Medicare annual enrollment.

If I’m happy with my coverage, do I really have to do anything?

“The simple answer is yes,” says Nicole Durtiz, former vice president of health education and outreach with AARP.

Here’s why: Although you’re not required to take any action to hold onto your current plan for 2018 (as long as it’s still being offered next year), doing so without shopping your options could cost you. Changes that occur in Medicare Advantage and prescription drug plans each year can alter your coverage in ways that may no longer work for you or your wallet.

You may be happy with your coverage this year and assume it will be identical in 2018, Durtiz says, “but that’s often not the case.”

What people tend not to realize until it’s too late is that their doctor is no longer covered by their plan, or that the medications they take have been moved to a different, higher cost drug tier, meaning higher out-of-pocket costs at the pharmacy. “They wouldn’t know that until it’s too late if they haven’t done that investigation,” Durtiz says. Her advice: “Spend a little bit of time making sure your needs haven’t changed and the insurance company hasn’t made a business decision that impacts your coverage.”

What’s the best plan for me?

“This is the most common question we get,” Baker says.

Unfortunately, there’s no one right answer. “We can’t tell people which plan is the best of the best for them. It’s an individualized decision,” he says.

However, there are some rules of thumb to follow that can help you get at the right choice.

In many markets, you may have 30 or more plans from which to choose, so start by limiting your options to avoid feeling overwhelmed. You can do that by using the Medicare Star Ratings system, which rates plans on a scale of one to five stars, with five being the best, based on the agency’s assessment of medical services and customer satisfaction. Filter out lower-rated plans and stick with just those that have received four and five stars. “That may be a way to cut the list in half,” Baker says.

He also suggests having a conversation with your doctors or pharmacist. “They may steer you away from plans that don’t do a good job covering the stuff you need,” he says.

Durtiz suggests people focus on “the four Cs” to making shopping easier: cost, coverage, convenience and customer service.

First up is cost. Look beyond a plan’s monthly premium and evaluate deductibles and other costs, such as copayments and coinsurance you’ll be required to pay when you go for care.

Also evaluate the type of coverage you’ll gain with each plan. You’ll want to make sure that your doctor and other providers participate and your medications are covered, plus check for any rules you’ll have to follow to get help paying for them. For example, will you be required to try a less expensive generic medication before gaining approval for the pricier brand-name drug your doctor prescribed? Does the plan impose medication quantity limits or prior approval in order for your medications to be covered? All this can impact your access to care and your costs.

Convenience is an important consideration as well, Durtiz says. “If you pick a plan and the only pharmacy is two subway stops and a bus ride away, or if the only hospital is a county away, that’s an issue.” Make sure the providers you need to use are conveniently located to your home.

Finally, whether you shop online or with the help of an expert, check those star ratings to get a sense of how plans do on customer service. “See how well they interact with clients, handle disputes and how quickly they answered the phone,” Durtiz says.

How can I find out if Medicare covers the drug or treatment I need?

There are many reputable sources where you can get free information to assist you in making your plan selection.

You can log onto Medicare.gov or call 1-800-Medicare to ask service representatives about the specific care you need.

The Medicare Rights Center offers an online interactive tool where you can ask and receive answers to your questions at medicareinteractive.org.

AARP also has a Medicare Questions and Answers Tool available both in English and Spanish.

And private sites such as eHealthMedicare.com provide online question and answer tools. There, you can also connect with insurance agents specializing in Medicare Advantage and prescription drug plans for free assistance with your selection process.

“The other way of doing it is by asking your providers,” Baker says. “They deal with these plans for a lot of different people.”

Often, your doctor’s office can tell you which plans do a better job covering the particular drugs or treatments you need.

Where do I go for help signing up?

To review your plan options, log onto the Medicare plan finder at medicare.gov or call 1-800-Medicare.

There are also free, personalized counseling services available around the country through State Health Insurance Assistance Programs. To find help near you, log onto shipnpr.shiptalk.org or call 1-800-677-1116.

And Medicare.com can connect you with licensed insurance agents able to help you find and sign up for a plan.

“The decision seniors make in the last few days of annual enrollment will impact their finances and possibly their health for the next full year. Getting it right is imperative,” DeLuca says.

Baker agrees, but says people are often fearful of the process or of making the wrong choice. They become frozen and do nothing, which is perhaps the biggest mistake of all. “It is a hard decision but not so momentous that you won’t be able to do it.”

The Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. Enrollment in plans depends on contract renewal.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800- MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.

Not affiliated with or endorsed by any government agency.

Every year, Medicare evaluates plans based on a 5-star rating system.

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