It is open enrollment for Medicare! What does that mean? It means that from October 15th through December 7th, Medicare members have an opportunity to shop their Medicare insurance coverage. Whether you have traditional Medicare (Part A) through the Federal government, with or without a Medicare Supplemental plan (from a commercial insurer) and Part D (from a Medicare insurer) or you have a Medicare Advantage plan, with or without Part D, (from a Medicare insurer); it is a good idea to shop it annually during this open enrollment period.
I am most familiar with Medicare Advantage plans. As such, this post will discuss how BRPS helps its clients compare Medicare Advantage plans. There are many resources available for Medicare-eligible recipients to learn more about traditional Medicare, including Medicare.gov, New York StateWide Senior Action Council, and AARP to name a few. A Medicare Insurance Broker can also help.
How Can BRPS Help During Medicare Open Enrollment?
Here is how BRPS helps its clients shop their Medicare health insurance coverage during this open enrollment period. The first thing BRPS does is talk to its clients about their opinion on their current insurance and their health. Here is a list of some questions BRPS would ask its clients:
- Is your current insurer giving you problems? If yes, what are the problems, and how important are they to you?
- Have you started or stopped a new drug? Is it working for you? Do you plan to continue taking that drug? Are they seeing a new specialist?
- How important is it to keep your current doctors?
- Have you had any problems paying for your insurance/medical bills over the past year?
- How would you rate your health on a scale of poor to great?
The Client’s Perspective
It is important to understand the client’s perspectives on his/her current coverage for BRPS to make an informed recommendation. It also ensures BRPS is researching the things that are most important to them.
Each ANOC is specific to the insurance carrier and Medicare Advantage Product.
[Note: unfortunately, a provider list can change at any time. As such, there is no guarantee that your provider will stay with the insurer. Pay attention to your insurance company’s communications to watch for potential provider disruption.]
The next thing BRPS does is review the client’s Annual Notice of Change (ANOC) from his/her current insurance carrier. This document tells the member what is changing from his/her current insurance coverage to next year’s insurance coverage. Read this document carefully. If it refers to the insurance company’s website for more information, visit the insurer’s website to review that information.
For instance, the provider list will be on the insurance company’s website. BRPS will review the insurer’s website to check that the client’s providers will continue to accept the client’s insurance. When a provider is not on the list, BRPS and the client discuss the provider’s importance to the client.
What Should a Medicare Member Focus on?
Typically, a Medicare member’s highest medical cost is his/her prescription drugs. As such, one of the most important aspects of Medicare insurance is the insurer’s formulary. A formulary is the list of drugs your insurance company will pay for and it is listed in tiers. Tier one is typically generic drugs, with the highest tier being experimental/high-cost branded drugs.
You can check the insurer’s formulary on its website, which will be the most accurate. BRPS finds it easier to use Medicare.gov’s plan finder to see if its client’s current plan continues to cover the client’s prescriptions. You will need to add your drug list and pharmacy to get an accurate estimate, but BRPS believes it is worth the effort. Once BRPS determines which providers and prescriptions are covered by the client’s current plan, BRPS will estimate how much the client is expected to pay for the following year. BRPS does this by utilizing the client’s past year’s medical expenses.
Understanding Past Medical Expenses
To understand the client’s medical expenditures, BRPS downloads the client’s bank, credit card, and claims information. The bank and credit card information is used to match payments to the expected member’s liability from the claims information. BRPS downloads the medical information from the insurance company and the pharmacy benefit manager. This information is used to match the information between the pharmacy benefit manager and the pharmacy claims from the insurer.
Utilizing this information, BRPS compares the estimated out-of-pocket expense to the expected out-of-pocket expense suggested by the plan finder. Once BRPS is confident that the plan finder is estimating expected expenses reasonably, it is time to compare the client’s current plan to other plans.
Note: For my clients, BRPS has noticed that the insurance company’s claim system cannot accurately reflect the pharmacy information after the client reaches the “donut hole.” If a client comes through the “donut hole”, the claim information agrees again. As such, BRPS calculates that the insurer and pharmacy benefit manager have calculated the “donut hole” claims correctly and then utilizes the pharmacy benefit manager’s claims download to reconcile the claims to the amount paid by the client. For more information on how the “donut hole” works, visit https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/costs-in-the-coverage-gap.
Using Medicare.gov to Compare Plans
BRPS utilizes the Medicare.gov’s plan finder to compare plans as well. This site gives you the monthly premium per plan, deductibles, out-of-pocket maximum, copays/coinsurance amounts, and other ancillary benefits offered. You can also compare greater detail of up to three plans side by side.
When BRPS compares plans for its clients, it focuses on:
- What are the Star ratings? Just like you look at movie ratings or contractor ratings, Start ratings rate the Medicare Advantage plan. The rating has a large part based on member satisfaction, as well as adherence to medical protocols. 5 Stars is the highest rating.
- Does the insurer cover the client’s current drugs? How much will the client’s current drugs cost him/her out-of-pocket?
- What will the client’s prior-year doctor visits cost him/her? Pay attention to specialist vs. primary care co-pays and in and out-of-network costs.
- How much will an inpatient stay cost the client, if one is required?
- What is the out-of-pocket maximum? Can the client afford that? Can the client afford higher monthly premiums to reduce the out-of-pocket maximum or inpatient cost? Are there other government programs that could help the client afford it? See “Do You Need Assistance” for government programs that might be available to help with health insurance costs.
- Ancillary benefits do not play heavily into the decision of which insurance to choose. Still, the plan comparison will show you what ancillary benefits are being offered by each plan.
In Summary
Everyone is different and BRPS customizes this review, based on the risk tolerance and financial means of its clients. BRPS is confident that it can help all clients get their financial and legal lives in order through direct help or through referral.
Let’s find out how BRPS can help you!