What to know about selecting health plans

Although a broader window for Medicare enrollment has closed, some retirees have another opportunity to make changes to their coverage.

Medicare Advantage open enrollment is available from Jan. 1 through March 31.

Medicare Advantage plans are offered by private insurers as an alternative to original Medicare. Generally, Medicare Advantage may cover Medicare Parts A and B, as well as Medicare Part D prescription drug coverage and other potential extra benefits.

During this open enrollment period, individuals who are already enrolled in a Medicare Advantage plan may switch to another Medicare Advantage plan. Alternatively, they may drop their current Medicare Advantage plan and opt for Medicare original coverage.

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To be sure, there will be more options later in the year during a broader open enrollment period that lasts from October to December, when Medicare original enrollees may also opt to change plans.

For beneficiaries who are eligible to make changes during this time, it’s important not to ignore this window, according to Juliette Cubanski, deputy director of the program on Medicare policy at KFF, a provider of health policy research.

“Plans can change considerably from one year to the next,” Cubanski said. “If people don’t compare their coverage to other options, they may not know that they’re going to be faced with higher costs.”

In order to be confident that you’re getting the best deal, it helps to evaluate how your current Advantage plan may have changed since last year.

You may be faced with higher costs if your personal prescriptions have gone up, for example, or your preferred medical provider is no longer in network.

Digging into those plan changes now can help avoid “bad surprises” later, according to Cubanski.

“Make sure the coverage that you have is going to continue to be the coverage that works best for you,” Cubanski said.

To be sure, Medicare Advantage plans have received negative attention because in some cases coverage was denied for necessary care.

Medicare Advantage plans are more likely than traditional Medicare to use prior authorization, approval needed before a patient can receive certain services or medications. However, because prior authorizations that have been denied are frequently overturned when they are appealed, that has prompted questions as to whether the plans are avoiding coverage obligations.

Medicare Advantage plans are more likely than original Medicare to offer extra benefits — such as dental, vision and hearing — that elderly beneficiaries need.

Most Medicare beneficiaries — 83% — consider supplemental benefits to be important to their coverage, according to a recent survey from The Commonwealth Fund, a provider of independent research on health care issues.

Notably, a larger share of Medicare Advantage enrollees — 89% — said supplemental benefits are important to them, versus 74% of traditional Medicare enrollees, The Commonwealth Fund found.

“People on Medicare, both older adults and those with disabilities, generally really need dental, hearing and vision services, as well as other benefits that are typically offered by Medicare Advantage plans,” said Gretchen Jacobson, vice president of Medicare at The Commonwealth Fund.

Beneficiaries who are in traditional Medicare may not have coverage for those same services unless they are able to purchase a supplemental plan or they qualify for Medicaid, Jacobson said.

When it comes to comparing Advantage plans, beneficiaries do not have to go it alone, Cubanski noted.

State-based organizations — the State Health Insurance Program, or SHIP — provide assistance to Medicare beneficiaries to help sort through their plan options.

Unlike insurance brokers or other professionals, these organizations do not have a financial interest to sign people up for certain plans, Cubanski said.