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8 Steps to Picking the Right Medicare Plans During Open Enrollment


Oct. 18, 2018 Kiplinger

Most people fill Medicare’s coverage gaps by buying a Medicare supplement (medigap) plan and a Part D prescription-drug plan, or they get both medical and drug coverage from a private insurer with a Medicare Advantage plan. You have from October 15 to December 7 each year to pick a Medicare Part D prescription-drug plan or a Medicare Advantage plan for the year ahead. You can switch from one Part D plan to another, or from one Medicare Advantage plan to another. You can also switch into a Medicare Advantage plan. However, if you have Medicare Advantage and want to switch to a medigap plan plus a Part D plan, you may have limited medigap options depending on your health—although you can choose any Part D plan during open enrollment.

The plan that was best for you over the past year may not be the best one next year. That may be because the drugs you take or the doctors you see have changed. Or it may be because the coverage has changed under your plan for next year—your drugs may be moving to a more expensive pricing tier with higher co-payments, or your doctors may be leaving your Medicare Advantage plan’s network. Or new plans may be introduced in your area that are a better match for you. Mutual of Omaha is entering the Part D market in several states, for example, and more insurers are introducing prescription drug plans or Medicare Advantage plans with lower premiums. Because you can change plans every year, you can focus specifically on your drugs and dosages or the type of health care you need now; you can switch again next year if your needs or your options change.

Let’s get started.

Forecast Your 2019 Health-Care Needs

Gather a list of your drugs and dosages that you’ll continue to take in 2019. If you have a Medicare Advantage plan, review the types of medical care you received over the past year, and try to predict the types of care you’ll receive in 2019. You never know what will happen to your health, but you may have some regular expenses that you know will continue – such as visits to certain specialists – and may anticipate some special medical needs for the upcoming year. All of this information will help you choose a plan for next year.

Review Your Current Plan’s Annual Notice of Change

You should have received this form around the end of September. It will indicate any changes for 2019 to the cost and coverage of your current plan. Pay particular attention to changes to drug formularies, drug tiers and co-pays that affect drugs you take. For instance, a drug that had been in a preferred co-pay tier — with a $10 co-pay, for example — may have moved to a nonpreferred tier for 2019, now with a co-pay of $20 or more.

Fire Up Medicare’s Plan Finder

Even if your current coverage isn’t changing, it’s still a good idea to compare all of your options during open enrollment, and a great way to do this is with the Plan Finder at Medicare.gov, which posted details about all of the 2019 plans starting on October 1. The tool makes it easy to compare the premiums and co-payments for all of the plans available in your area, and it also estimates your total out-of-pocket costs for your drugs and dosages (and also for your general health condition, if you have a Medicare Advantage plan). This is the best place to start shopping.

For Part D, type in your zip code, the drugs you take and the dosages to compare plans. The online tool will calculate your total costs (premiums plus out-of-pocket costs for your drugs) for each plan in your area.

For Medicare Advantage plans (called “Medicare Health Plans” in the tool), you’ll add your general health condition (the default is “good,” but you can also choose “poor” or “excellent”) in the “refine your search” column to estimate the total costs for the year for someone with your general health status.

Compare Plan Costs

The Part D plan with the lowest premiums may not be the least expensive overall if you have high co-payments for your drugs. The average Part D premium for 2019 will be $32.50 per month. That’s actually $1 less than 2018’s average, primarily because several large insurers are offering low-premium plans (sometimes less than $20 per month) with preferred pharmacies. (More on preferred pharmacies in a moment.) Co-payments can vary a lot depending on your drugs and the pharmacy you use. The Medicare Plan Finder will reveal how much you’re likely to pay for premiums plus co-payments over the year.

Likewise, if you’re shopping for a Medicare Advantage plan instead, look carefully at plans’ coverage and co-payments for the types of medical care you usually use. The average Medicare Advantage premium is about $30 per month, but some plans have $0 premiums because they may have some of the smallest provider networks and generally require higher co-payments for doctor’s visits, hospital stays and other types of care.

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