Information on Comparing Medicare Plans

By: Oraida Roman

President, Senior Products - Humana's Intermountain Region

If you have Medicare Parts A and B, choosing a Medicare plan can sometimes prove confusing, challenging and time-consuming. But the Centers for Medicare & Medicaid Services makes it easier for beneficiaries to navigate the Medicare landscape by rating the health plans.

Much like the ratings used by some movie reviewers, Medicare’s five-star assessment grades the excellence of Medicare Advantage and prescription drug plans nationally. A 5-star rating represents an excellent plan and a 1-star a poor performer.

The data that support the ratings comes from sources such as surveys, first-hand observation, billing data and medical records. Medicare plans receive overall or summary ratings that combine all categories and measures into a single rating.

The system helps people compare Medicare plans so they have information they need to choose a higher quality plan and better health care. It’s especially useful now as the Medicare Advantage and prescription drug plan annual open enrollment period (Oct. 15 – Dec. 7) approaches. This is when people who have both Medicare Parts A and B can choose a Medicare plan for the first time or change their current plan for the coming year.

 The rating system uses more than 50 different quality measures in five categories. They include:

·         Staying healthy via preventive services

·         Managing chronic conditions such as diabetes and high blood pressure

·         Evaluating a plan’s responsiveness and service

·         Considering member complaints, appeals and voluntary disenrollment

·         Assessing the quality of customer service. 

Medicare is tough when issuing its top ratings. For 2013, only four Medicare Advantage-only plans are five-star performers. The rating system is a simple, authoritative starting point. Because Medicare releases new star ratings each year, the ratings reflect recent measures of how a plan performs on the quality front. These marks also increase the level of accountability for the care provided by physicians, hospitals and other providers.

People should use the ratings in several ways. First, they should acknowledge that each plan is different – with different pricing, benefits, and health care provider networks. Second, they should determine if the plans performed better in 2013 than 2012 and also compare them to original Medicare.

 Here are four considerations to look at when choosing a Medicare plan:

1.    Review all of your options. In 2013, beneficiaries in nearly every U.S. county are able to select from an average of 26 plans.

2.    Decide what benefits you want based on your health care needs. There is a wide range of plans so determine your specific wants and needs. Do you require a certain type of specialty care? Do you want to keep a favorite doctor? 

3.    Determine which plans you can afford since cost is usually a major factor in deciding which health care plan will best suit your needs. Don’t just consider the plan with the lowest monthly premium. Find out if a plan requires a copayment or has a high annual deductible to meet before it pays any of your health care expenses.

4.    Enroll in the plan that best fits your needs and budget.

 So before you enroll in a Medicare plan, check the star ratings at the Medicare Plan finder website at https://www.medicare.gov/find-a-plan/questions/home.aspx. While there are other online tools for analyzing all of the Medicare plans available to you, visit Medicare.gov and use the Plan Finder for a simple tool that will help you compare health care plans.

 For instance, to compare Medicare plans, simply enter your zip code, select “Medicare Health Plan,” and choose the type of Medicare coverage you’re interested in. The Plan Finder will display your out-of-pocket costs, including premiums, deductibles, co-insurance and copayments, that you would pay during the year for each plan. 

So, note on your calendar that Oct. 15 – Dec. 7 is this year’s Medicare Advantage and prescription drug plan open enrollment period.  Be sure to take advantage of the star ratings and tools in place to help determine the best Medicare plan for you for 2014.