Information to help you buy the Medicare Advantage and Medicare Part D drug plans

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It’s that time of year for seniors looking to find a Medicare Managed Care or Prescription Drug Plan for 2022.

Open enrollment begins Friday, October 15 for Medicare Advantage managed care plans and Medicare Part D prescription drug plans. Optional plans are available to everyone covered by Medicare, the federal health insurance program for individuals. people 65 years of age or older and some young Americans with disabilities.

Registration will continue until December 7. The changes will take effect on January 1.

Consumers can choose to include prescription drug coverage in Medicare Advantage plans. They also have the option of choosing a stand-alone Medicare Part D prescription drug plan to use with original Medicare, retiree health coverage, or a Medicare supplemental plan, also known as the Medigap plan.

Nationally, Medicare Advantage continues to be popular, with enrollment numbers set to reach an all-time high of 29.5 million beneficiaries from the current workforce of 26.9 million, according to the Centers for Medicare & Medicaid Services .

For 2022, nearly 2.4 million Medicare-eligible Ohio residents can choose from 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 the providers offering coverage.

In Ohio, the average monthly Medicare Advantage premium declines 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 Senior Health Insurance Information Program (OSHIIP), and Francine Chuchanis, Director of Benefit Entitlements for Direction Home Akron Canton Area. Agency on Aging and Disabilities, which reviews available Medicare Advantage plans. in Summit, Portage, Wayne and Stark counties each year.

Do a diet checkup every year

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

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

If you are already enrolled in a Medicare Advantage plan, you will receive an annual notice of coverage, which will let you know if your premiums or co-payments are increasing or if there are other changes to your plan.

“It’s a great starting point. If I see my double premium, that’s a great sign that I want to review my plan, ”she said.

If you want to keep your plan, you don’t have to do anything and it will automatically renew, Reeg said.

But everyone should still take stock, including on their medications, as costs could change under the same provider, she said.

“We don’t usually check insurance on an annual basis,” Reeg said. “It can really save hundreds, if not thousands of dollars just by looking at these plans.”

Call your existing doctors

If it’s important to stay with your doctor, call them to make sure your doctor will be networked for the plan you choose, Chuchanis said.

The plans change coverage every year, so your doctor may not always be in the network, Chuchanis said.

“Before you make your choice, call the hospital, call your doctor and make sure they agree to the plan,” she said.

Consider your specific needs and costs

“It’s not a one size fits all,” Chuchanis said. Often spouses will benefit from joining different plans, depending on their medical needs, she said.

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

It’s especially important to look at the total annual cost of plans, including the cost of premiums and drugs, as well as out-of-pocket expenses, when evaluating the best plan for you, she said.

“People with high medical bills also need to consider how much they can get out of their pocket,” she said. “Once they hit that limit, they don’t have to pay high medical bills.”

Look at the services you use the most, Chuchanis said. If you are going to have knee replacement surgery, consider your potential hospital costs. If you see a lot of specialists, compare the co-payments between plans, she said.

For prescription drug costs, enter your medications at www.medicare.gov and do a cost analysis, Chuchanis said. It also warns people to stay in the network for your pharmacies.

“When they go to the pharmacy, don’t ask them, ‘Are you taking this plan?’ “she said.” You have to ask, “Are you a network pharmacy with this plan?” “

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

People who qualify for additional help based on their financial resources can get some plans without paying a premium or at a reduced premium. To verify https://www.ssa.gov/benefits/medicare/prescriptionhelp.html or call 1-800-772-1213 for more information.

Overall, Chuchanis said that when analyzing plans in the Akron area, she saw very few increases in overall monthly premiums. Reeg said his experts noticed premiums across the state remained stable.

Chuchanis has seen many co-pay cuts to see primary care physicians, with the majority of plans having no co-payment.

“This indicates that they are really pushing people to go to the doctor and get these preventative services,” she said.

Free can be good, but the watch is expensive

No-premium plans can provide good coverage for consumers, but be sure to factor in any out-of-pocket costs, experts said.

Contrary to the old adage that “you get what you pay for,” there are many zero-premium Medicare Advantage plans with good coverage because Medicare pays for the 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 beneficiaries who subscribe to the plans. Everyone except the poorest pays part of the monthly premium; the government takes the rest.

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

“Health insurance is based on ‘if’. You want to know what will happen if you are in this situation and know what your co-pay is [is] should you be admitted to the hospital, ”Reeg said.

But make sure you know all of your costs, because a $ 0 premium plan will always have other costs for co-payments and drugs, she said.

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

“I would suggest that you don’t choose your health insurance based on additional benefits. Choose based on your health care benefits and look at the added benefits as they are – extra freebies or the icing on the cake, ”Reeg said.

For example, a senior may still qualify for a $ 10 per month gym membership versus a “free gym membership” with an insurance plan, she said.

New this year, some plans offer to pay the Medicare Part B portion of a person’s costs, Reeg said. She again suggests looking at the total costs of the plans when comparing.

Look at the number of stars

Consumers are encouraged to use Medicare quality star ratings to help evaluate plans. They are often released around October 15, that is, Friday.

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

Chuchanis said she would be wary of any plan with less than 3 stars.

Some plans will also be listed as “too recent to assess”, meaning there is not enough data for assessment.

Chuchanis and Reeg said that was not a necessary reason to avoid a business.

You can call your doctor’s office to see if he has had any experience or contact with the company, Chuchanis said.

Watch out for fraud

Reeg said the state sees a slight increase in unscrupulous sales tactics during the open listing season.

“We strongly advise against making registration decisions based on TV commercials, marketing material in their physical mailbox or email inbox. These are often just lead generators to capture your data so agents can call you directly, ”she said.

Don’t share your Medicare number, Social Security number, or banking information unless you know who you are talking to, Reeg said.

Medicare does not call individuals and Medicare does not issue new cards due to the pandemic, another fraud, Reeg said.

If you have a problem with your health insurance plan at any time of the year, Reeg suggests trying to resolve it with the plan first. If that doesn’t work, contact OSHIIP at 1-800-686-1578 and the agency can open a case to help you.

Local Medicare Advantage Plans

In Summit County, there are 70 Medicare Advantage managed care plans that help pay for doctor visits, hospital stays, and other medical services. This is down from 77 plans in 2021. All but 13 include coverage for prescription drugs.

In Summit County, 48 Medicare Advantage plans do not have monthly premiums for enrollees.

Part D plans

This year, 23 Part D prescription plans are offered across the state of Ohio, up from 30 previously.

Part D plans cover prescription drugs for consumers who are not covered by a Medicare Advantage plan, which typically includes prescription drug coverage.

The cheapest monthly premium is with Aetna’s SilverScript SmartRx, which is $ 7.10 per month; the most expensive is United Healthcare’s MedicareRX Preferred plan at $ 99 per month. However, as with Medicare Advantage plans, experts caution against choosing a plan based solely on price. Be sure to check if your prescription drugs are covered and at what cost.

The average monthly premium is $ 44.96 and only four plans have an annual drug deductible of $ 0, Chuchanis said.

Beacon Journal reporter Betty Lin-Fisher can be reached at 330-996-3724 or [email protected] Follow her @blinfisherABJ on Twitter or at www.facebook.com/BettyLinFisherABJ. To see her most recent stories and columns, visit www.tinyurl.com/bettylinfisher.


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