Shopping for Medicare plans? Here's where to start

"We highly caution people from making enrollment decisions based on television ads, marketing material in their physical mailbox or their email box. Those are often just lead generators to capture your data so agents can call you directly."

Chris Reeg

Director of the Ohio Department of Insurance's Ohio Senior Health Insurance Information Program (OSHIIP)

It's that time of year for older adults looking to find a Medicare managed care or prescription drug plan for 2022.

Open enrollment begins Oct. 15 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 will continue through Dec. 7. Changes are effective Jan. 1.

Consumers can choose to 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.

Nationally, Medicare Advantage continues to be popular, with enrollment projected to increase to an all-time high of 29.5 million beneficiaries from the current enrollment of 26.9 million, according to the Centers for Medicare and Medicaid Services.

For 2022, nearly 2.4 million Ohio residents eligible for Medicare can select from among 23 Medicare prescription drug plans, which are offered statewide.

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

In Ohio, the average Medicare Advantage monthly premium is going down for 2022 to $18.75 from $20.18 in 2021.

Here's some advice from Chris Reeg, director of the Ohio Department of Insurance's Ohio Senior Health Insurance Information Program (OSHIIP) and Francine Chuchanis, director of entitlement rights for Direction Home Akron Canton Area Agency on Aging and Disabilities, who reviews the Medicare Advantage plans offered in Summit, Portage, Wayne and Stark counties yearly.

Do a plan check-up every year

Whether this is your first year shopping for a plan or you're a pro, plan offerings change every year, so it's important to review your coverage to make sure you still have the best one for next year, said Reeg.

Don't assume your plan from last year will have the same benefits this year or that it is the best plan for you for 2022, she said.

If you are already enrolled in a Medicare Advantage plan, you will get an annual notice of coverage, which will tell you if your premiums or copays are going up or if there are other changes to your plan.

"It's a great starting point. If I see my premium is doubling, that's a big sign I want to review my plan," she said.

If you want to stay with your plan, you do not need to do anything and will be automatically renewed, Reeg said.

But everyone should still do a check-up, including on their medications because costs could change under the same provider, she said.

"We're not in the habit of checking insurance on an annual basis," said Reeg. "It truly can save hundreds, maybe thousands of dollars just by looking at those plans."

Call your existing doctors

If staying with your doctor is important, call to make sure your doctor will be in network for the plan you choose, Chuchanis said.

Plans change coverage yearly, so your doctor may not still be in network, Chuchanis said.

"Before you actually choose, call the hospital, call your doctor and make sure that they take the plan," she said.

Consider your particular

needs and costs

"It's not a one-size-fits all," said Chuchanis. Often spouses will benefit from enrolling in different plans, depending upon their medical needs, she said.

Look at the costs of services you use most, like specialists or medications, when comparing Medicare Advantage plans, said Chuchanis.

It is especially important to look at the total yearly cost of plans, including premium and drug costs, as well as out-of-pocket limits, when weighing the best plan for you, she said.

"People with high medical costs also need to look at what their maximum out of pocket will be," she said. "Once they hit that limit, they don't have to pay for high medical expenses."

Look at the services you use the most, Chuchanis said. If you're going to get a knee replacement, look at your potential hospital costs. If you see a lot of specialists, compare the copays among plans, she said.

For prescription drug costs, input your medications into the www.medicare.gov site and do an analysis of costs, said Chuchanis. She also warns people to stay in network for your pharmacies.

"When they go to the drug store, don't ask, 'Do you take this plan?' " she said. "You need to ask, 'Are you an in-network pharmacy with this plan?' "

Sometimes mail order can be cheaper, but not always, so check the Medicare website, she said.

Individuals who qualify for extra help based on their financial resources can obtain some plans without paying a premium or at a reduced premium. Check https://www.ssa.gov/benefits/

medicare/prescriptionhelp.html or call 1-800-772-1213 for more information.

Overall, Chuchanis said in analyzing plans in the Akron region, she saw very little increases in overall monthly premiums. Reeg said her experts noticed premiums statewide stayed steady.

Chuchanis saw many reductions in copays to see primary care physicians, with the majority of plans having no copay.

"That indicates they're really pushing people to go to the doctor and get those preventative services," she said.

Free can be good, but watch costs

Zero-premium plans can provide good coverage for consumers, but make sure you look at all of the out-of-pocket costs, experts said.

Unlike the old adage of "you get what you pay for," there are many zero-premium Medicare Advantage plans with good coverage because Medicare pays plans to participate and subsidizes some costs, Reeg said.

The federal government contracts with private insurance companies to provide drug and/or medical coverage to Medicare recipients who sign up for the plans. Everyone but the poorest enrollees pays a portion of the monthly premium; the government picks up the rest.

Consumers have to choose a plan based on their current health needs for the next year, as well potential costs "if you have the worst health year ever," she said.

"Health insurance is based on the 'if.' You want to know what's going to happen if you are in that situation and knowing what your copay should you be admitted to the hospital," Reeg said.

But make sure you know all of your costs as a $0 premium plan will still have other costs for copays and medications, she said.

Many Medicare Advantage plans offer extra benefits for dental, vision and hearing and other "extras" such as home and bath safety devices or emergency response devices.

"I would suggest not choosing your health insurance based on the added benefits. Choose based on your healthcare benefits and look at the added benefits just as they are — extra goodies or icing on the case," said Reeg.

For instance, a senior citizen may still qualify for a $10 a month membership at a gym compared to a "free gym membership" with an insurance plan, she said.

New this year are some plans that are offering to pay the Medicare Part B portion of a person's costs, said Reeg. She again suggests looking at total costs for the plans as you compare.

Look at star ratings

Consumers are encouraged to use Medicare's quality star ratings to help evaluate plans. They often are released on or about Oct. 15.

Managed care and drug plans are rated on a 1-to-5 star scale, with 1 star representing poor performance and 5 stars representing excellent performance.

Chuchanis said she would be wary of any plan with less than a 3-star rating.

There also are some plans that will be listed as "too new to be rated," which means there is not enough data for the rating.

Chuchanis and Reeg said that isn't necessary a reason to avoid a company.

You might call your doctor's office to see if they've had any experience or contact with the company, Chuchanis said.

Be careful of fraud

Reeg said the state sees an uptick in unscrupulous sales tactics during open enrollment season.

"We highly caution people from making enrollment decisions based on television ads, marketing material in their physical mailbox or their email box. Those are often just lead generators to capture your data so agents can call you directly," she said.

Do not share your Medicare number, Social Security number or bank information unless you know who you are speaking to, said Reeg.

Medicare does not call individuals and Medicare is not issuing new cards because of the pandemic, another fraud, said Reeg.

If you have a problem with your Medicare plan anytime of of the year, Reeg suggests trying to work it out first with the plan. If that doesn't work, contact OSHIIP at 800-686-1578 and the agency can open a case to help.

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 To see her most recent stories and columns, go to www.tinyurl.com/bettylinfisher

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Betty Lin-Fisher

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"We highly caution people from making enrollment decisions based on television ads, marketing material in their physical mailbox or their email box. Those are often just lead generators to capture your data so agents can call you directly."

Chris Reeg

Director of the Ohio Department of Insurance's Ohio Senior Health Insurance Information Program (OSHIIP)