10 Must-Ask Questions When Comparing Medicare Advantage Plans

October 22, 2018

By: Ann Kayrish, NCOA’s Senior Program Manager for Medicare

This open enrollment people with Medicare will have more plans to sift through than in past years. The Centers for Medicare & Medicaid Services (CMS) will now allow Medicare Advantage (MA/Part C) plans to offer an increased number and variety of plans in a service area. Medicare Advantage plans will also be able to provide benefits not previously covered by Medicare called “additional benefits.” These can include transportation vouchers, meals deliveries, alternative health treatments and opportunities to reduced enrollee cost-sharing.

The additional benefits and increased number of plans mean you may need to spend more time analyzing Medicare plans as you shop for coverage in 2019. Prior to enrolling in any plan, contact your health care providers to confirm their participation in the MA 2019 plan network. You’ll also want to ask each plan whether you are eligible for additional benefits or discounts on costs based on your health conditions or providers. Use the checklist of questions below to help you research and compare MA plans.

Questions to ask your providers (doctors, hospitals, labs, suppliers)

  • Are you a participating provider in the “ABC Medicare Plus Plan [example plan]” network in 2019?
  • Are you accepting any new “ABC Medicare Plus Plan” patients? If I join your plan as of January 1, when will I be able to schedule an appointment?
  • Under the “ABC Medicare Plus Plan”, what would my copayment be for services at your office or facility?
  • With “ABC Medicare Plus Plan” will I need a referral to be seen at your office or facility?

Tips: Be sure to use the entire name of the new plan you are considering enrolling into since some providers may participate with some, but not all plans offered by a Medicare Advantage organization.  For example, a provider may participate in the “ABC Medicare Plus Plan” network, but not participate provider under the “ABC Medicare Standard Plan” network.

Doctors may close their practice to new enrollees or leave a plan during the year, so check with them before enrolling in a plan. Be sure to mention any health conditions or diagnosis, for it may impact the amount you pay when seeing a provider.

Questions to ask MA plans before enrolling  

  • Are the providers I use in your plan network for 2019?
  • Does your MA plan offer additional benefits? Please describe the supplemental benefits, their maximum dollar value and limitations.
  • Can I further reduce my cost-sharing/copay by using designated in-network providers? Can my diagnosis or health status affect or reduce what I pay for services?

Tips: If you would like to keep your same providers, make a list of them to discuss with your MA plan. Medicare Advantage plans will now offer additional benefits such as meal delivery programs, but there may be special circumstances for enrollment like after a hospitalization and for a limited number of meals. A transportation voucher program may be limited to an annual or monthly cap or participating taxi service providers.

Some MA plans may offer reduced cost-sharing to targeted populations (individuals with diabetes or hypertension for example) or have specific providers that reduce your cost-sharing. You should ask the plan if it offers reduced costs sharing for targeted populations.

Questions to ask prescription drug plans before enrolling 

  • Does the plan under consideration cover all the drugs I believe I’ll need in 2019?
  • Am I able to get my medications at a preferred price at my pharmacy of choice?
  • How and will I receive notice of prescription drug formulary changes? How will I receive notices when newly available generics are substituted for brand-name drugs currently on the formulary?

Tips: Have a list of drugs that you take, along with the prescribed strength, dosage, and route of administration prepared before contacting the plan. This will make it easier to determine if they are on the plan formulary and if any restrictions are imposed such as prior authorization, step therapy, or quantity limits.

Preferred pharmacies typically offer drugs at the lowest copay or co-insurance.  Ask about the cost associated with local pharmacies and the mail orders.  Keep in mind that the lower cost must always be weighed against convenience.  A lower cost at a pharmacy across town or not on a bus route may not be worth the reduced accessibility.

Additional Information

The new Medicare Advantage Open Enrollment Period (MA OEP) that runs from January 1 – March 31 allows individuals enrolled in an MA plan as of January 1 to make a one-time election to another MA plan or return to Original Medicare and a standalone Medicare Part D plan. This enrollment period does not allow for Part D or Medigap changes for individuals enrolled in Original Medicare. An MA organization can choose to be open or closed for enrollments during this period.

There are lots of resources available to help you make apples-to-apples comparisons of Medicare Advantage and Part D plans. We recommend you start by taking our Medicare Questionnaire assessment, which can connect you to free professional advice about Medicare from a licensed benefits advisor or contact your local State Health Insurance Assistance Program (SHIP).