Comparing and choosing your coverage
Open enrollment for 2018 is underway. These charts can help compare premiums, deductibles and drug coverage offered in your community by private insurers with Medicare contracts.
One chart details the 21 plans in Florida covering only prescription drugs. These stand-alone prescription plans, or PDPs, have the same benefits statewide. They appeal to those who want to stay on traditional Medicare, which does not cover drugs. These plans also help those who have medical coverage from a former employer that doesn’t include prescriptions.
Seniors with prescription, or Part D, coverage from private insurers pay additional premiums for those plans as well as their Part B Medicare premium, which covers such services as doctor’s visits and outpatient therapies. Part B is deducted from monthly Social Security checks.
The other charts in this guide show the Medicare Advantage healthcare plans available in your area. The majority include prescription coverage. Many also have attractive perks like gym memberships or transportation to doctors. Experts say, however, that you shouldn’t make your coverage decisions based on these splashy add-ons.
The appeal of Advantage plans is they usually offer extra benefits, such as drug coverage, and lower co-pays than Medicare. In fact, federal rules require all Advantage plans to provide at least the same level of coverage as traditional Medicare.
Most Advantage plans are true HMOs, or health maintenance organizations, limiting participants to network doctors, pharmacies and health care facilities. They usually do not require any premium, other than what you already pay for Medicare Part B. In the charts, this is notated as “Medicare Part B only.” Some will even pick up a portion of your monthly Part B payment. The charts list how much these plans will pay.
A few South Florida plans are preferred provider organizations, or PPOs. These allow more provider choice, don’t require referrals and may pay for some out-of-network services. They typically cost more and require additional premiums.
Private fee-for-service plans (PFFS) allow you to go anywhere. But make sure your doctors and hospitals accept these plans before enrolling. There are very few PFFS plans in Florida.
Advantage plans are not standardized. Drug and doctor co-payments, hospital coverage and other benefits can be different from county to county, even if the plan has the same name.
Special needs plans, or SNPs, offer lower-cost alternatives for those on limited incomes, who are on both Medicare and Medicaid, or who have chronic or disabling health conditions. There are SNPs for nursing home residents or people receiving long-term care services in other settings.
Carefully review the two prescription drug plans columns in the Medicare Advantage plans charts. These tell you what you’ll pay for your medications before reaching the coverage gap, or the “doughnut hole,” as well as what you’ll pay when you fall into the gap. Most plans require you to use their “preferred” pharmacy to get their lowest prices.
Some plans give the lowest co-payments to “preferred” generic and brand medications. To truly compare plans, you should make a list of all of your medications and ask insurance providers what coverage tiers they’ll fall under and what the co-payments will be. You also can plug your drug list into the Plan Finder on Medicare.gov to get an estimate.
Happy shopping!