4 Medicare Advantage shopping tips


Early December may be the least wonderful time of the year for Medicare Advantage customers who still haven’t settled on coverage plans for 2015.

Most people enrolled in the privately run version of the government’s Medicare program for the elderly and disabled people have until Sunday to decide whether they want to find a new plan for 2015. In some cases, they can take until the end of February to decide if their old one will not be offered next year.

Insurance experts say they are seeing more plan consolidation and changes as insurers trim low-quality coverage and adjust to government funding cuts for the program. Here are some important variables to consider if you need to find new coverage or want to make sure you still like your current plan.

COVERAGE: Make sure all your doctors or other providers are in the plan’s coverage network. This can change from year to year. Check your prescriptions, too, and figure out how much you will have to pay for each refill.

QUALITY: The more stars a plan has, the better under the government’s rating system for Medicare Advantage plans. Plans with higher ratings generally come with better benefits. That might mean lower deductibles, broader provider networks or perks like a gym membership.

COST: Look beyond simply whether the premium is high or low. Figure out what you get for that number. A low premium may come with high out-of-pocket costs, which could mean you have to pay a bigger deductible before most of the coverage starts.

OUT-OF-POCKET MAXIMUM: This is critical, because it tells you how much you are exposed to big medical bills. It’s the most you will spend in a given year on covered health costs, and these limits can vary by plan. Note that out-of-network care might not count toward the maximum. — AP