10 tips for picking the right Medicare option

It's that time of year for older adults looking to find a Medicare managed care or prescription drug plan for 2023.

Open enrollment started Saturday for the Medicare Advantage managed care plans and Medicare Part D prescription drug plans. The optional plans are available for everyone covered by Medicare, the federal health insurance program for people 65 or older and some younger disabled Americans.

Enrollment continues through Dec. 7. Changes are effective Jan. 1.

Consumers can include prescription drug coverage in Medicare Advantage plans. They also have the option of picking a stand-alone Medicare Part D prescription drug plan to use with original Medicare, retiree medical coverage or a Medicare supplemental plan, also called a Medigap plan.

What's new for 2023?

In 2023, all recommended vaccines, including shingles and tetanus, will be fully covered by Medicare Part D, which is either a stand-alone prescription plan or part of a Medicare Advantage plan, said Francine Chuchanis, director of entitlement rights for Direction Home Akron Canton Area Agency on Aging and Disabilities. However, to avoid a co-pay for the vaccine, consumers need to get their vaccines at a pharmacy and not at their doctor's office, she said.

For people who are not yet eligible for Medicare but will turn 65 next year, there are some changes that require you to plan ahead, said Chuchanis.

In 2023, if a person enrolls three months before turning 65, coverage will begin the month the person turns 65 unless the birthday falls on the first day of the month. In that case, the coverage will begin the month prior. If a person waits to sign up during their birthday month or three months after, coverage will not begin until the first day of the following month after enrollment.

The number of Medicare Advantage managed care plans available in each county will vary, depending on which providers offer coverage.

According to the Centers for Medicare and Medicaid Services, there are 216 Medicare Advantage plans available in Ohio for 2023, up from 202 in 2022.

The average monthly Medicare Advantage plan premium decreased from $18.17 in 2022 to $16.03 in 2023, according to CMS.

Chuchanis, who reviews the Medicare Advantage plans offered in Summit, Portage, Wayne and Stark counties yearly, said she noticed premiums in the Akron area are stable for 2023.

This year, there are 24 Part D prescription plans offered statewide in Ohio, up from 23 last year. Part D plans cover prescription drugs for consumers who are not on a Medicare Advantage plan, which usually includes prescription drug coverage. Chuchanis said she noticed that Ohio's Part D premiums were higher than the national average.

The national average premium for Part D plans is $31.08, according to CMS, while the Ohio average Part D premium is $47.07, she said. There are no Part D plans with no premium and four plans with $0 deductible.

Here's some advice from Chuchanis, who presents workshops throughout the region for seniors, and Chris Reeg, director of the Ohio Department of Insurance's Ohio Senior Health Insurance Information Program (OSHIIP).

1. Do a plan check up every year. You should receive an annual notice of change letter, which outlines if your premium will go up or other changes. A plan for 2022 may or may not be best plan for you in 2023.

2. If you want to stay with the same plan, you don't need to do anything. You will roll over automatically. "We still encourage folks to review what's available," said Reeg.

3. Call your existing doctors to see if they are in your plan. Providers can sometimes leave a plan in the middle of the year, so confirm that the doctors you want to see are in your plan, said Chuchanis.

4. Consider your particular needs and costs. This is not one-size-fits-all, said Chuchanis. Don't pick the same plan as your neighbor; it may not be a great plan for you, she said. Even husbands and wives need to look at their particular needs and what plan fits best, said Reeg. Look at your out-of-pocket costs for the services you use most, like specialists or medications, when comparing Medicare Advantage plans, said Chuchanis.

5. "Free" in this case can be good, but watch costs. Unlike the old adage of you get what you pay for, the government offers subsidies for Medicare Advantage plans, so that's why many can offer zero premiums. But Reeg still warns "please don't choose just on marketing material."

6. Choose a plan to cover you if you have the worst health year ever. Watch the maximum out-of-pocket limits so you know what it would cost, said Reeg. Some plans have a $3,000 out-of-pocket limit and some have $12,000, she said.

7. Extras are nice, but don't base your decision on them. Most plans offer vision and dental and gym memberships. "If you are joining a plan because of the perks, know the limitations," said Reeg.

Chuchanis said she has heard this year that there are some lucrative "extras" like cash cards, but that information is not on Medicare.gov, so you'll have to look at websites or marketing material. Some plans also added home health and transportation coverage. But as always, Chuchanis said, make sure the plan covers your medical needs the best before choosing from perks.

8. Check star ratings. CMS has updated how it does its star ratings slightly this year and put more emphasis on consumer assessments, including customer service, said Chuchanis. The ratings are out of a five-star system. Chuchanis said she does not recommend plans below a 3-star rating. In Summit County, there are four Medicare Advantage Plans with the highest 5-star rating: Devoted Health, MedMutual, Prime Time and SummaCare. There are three plans that fall below a 3-star rating for some of its plans: Cigna has some with 2.5 stars, Lasso Health Care has a 2 star and Wellcare has some with 2.5 stars. There are no statewide Plan D prescription drug plans with a 5-star rating.

9. Check if the plan will cover you out of state and out of the country. Some Medicare Advantage plans are national and some can have foreign travel coverage. If you travel or are a snowbird, check to make sure your coverage follows you.

10. Be careful of fraud. Plans are not supposed to call you or telemarket, unless you are already enrolled in the plan. Medicare does not call you to find a new plan. Reeg said her department already had more than 50 complaints from people who believe they have been misled.

Beacon Journal staff reporter Betty Lin-Fisher can be reached at 330-996-3724 or [email protected]. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ.