If a Medicare beneficiary is NOT flexible with making changes and they are considering enrolling in a Medicare Advantage Prescription Drug (MAPD) plan or switching their MAPD plan, below are seven questions to answer before making the switch.
1) Is your doctor in network with the MAPD plan?
2) How much will your prescription medications cost with the MAPD plan?
3) Is your dentist in network with the MAPD plan?
4) Is the pharmacy you like a “preferred pharmacy” with the MAPD plan?
5) What are the “extra benefits” with the MAPD plan?
6) What are the co-pays with the MAPD plan?
7) What is the Maximum Out of Pocket (MOOP) with the MAPD plan?
Doctors have a choice when it comes to Medicare, they can either choose to accept and bill Medicare or they can refuse to bill Medicare and work with patients who pay them directly. For the doctors who decide to accept Original Medicare they have to accept Medicare supplements because they complement Original Medicare. In regard to Medicare Advantage Prescription Drug plans, also known as Part C, doctors do not have to agree to accept them, meaning these doctors can treat patients on Original Medicare and reject working with Medicare beneficiaries on MAPD plans. In fact, each year private insurance companies who offer the MAPD plans have to come to an agreement with the medical facilities, if these two parties do not come to an agreement, the Medicare beneficiary can be left in a precarious situation. Unfortunately, this happens every year, people on MAPD plans either have to switch MAPD plans to one in network with their doctor or change their doctor(s). People see commercials that sound really good, but after calling the 800 number they quickly discover their doctor is not in-network with the advertised plan. Overall, MAPD plan networks are expanding, and enrollments are increasing year over year putting pressure on a lot more doctors to accept MAPD plans. Each medical facility decides which MAPD plans they will or will not accept. If you really like your doctor, start by asking which MAPD plans they are currently accepting, this will narrow down your options.
Medications are a major expense for a lot of Medicare beneficiaries. Make sure to pay really close attention to your out-of-pocket prescription drug expenses, this can be a major mistake some beneficiaries make. Comparing your existing plan drug formulary to any new plan will be challenging without software that can do the calculation. Make sure to analyze your current prescription drug costs to the new proposed plans. Newer MAPD plans generally will cost less for prescriptions and may come with enhanced extra benefits. It is highly recommended to review your MAPD ever year, compare it to the newest plans available in your zip code to make sure you are still in the right plan for you. If you work with a knowledgeable Medicare coach, they will be able to help compare plans in your zip code and help you make the right decision.
Original Medicare does not cover teeth cleanings, fillings, crowns, or root canals. This means people who are on Original Medicare with a Medicare Supplement will have to pay for their dental expenses out of their pocket or purchase dental insurance. Dental benefits are included on most MAPD plans which can save Medicare beneficiaries up to thousands of dollars. But here’s the bad news… a lot of dentists are going away from accepting insurance because they don’t want to deal with billing the insurance companies. Unfortunately, the dentist can get away with it because their patients are willing to pay for the services out of their own pocket. It is a complete headscratcher why someone would pay way more for dental work out of their own pocket and not switch dentists and use their insurance, but it happens all the time. If a MAPD plan beneficiary wants to pay as little as possible for dental expenses they should have a conversation with a Medicare coach and be open to making changes.
In some towns pharmacies used to be the local hangout. Apparently, you could have lunch, get a malt, and wash it all down with soda fountain drink. A lot has changed with pharmacies over the years, including the price it costs to fill a prescription. If a Medicare beneficiary wants to pay as little as possible for their medications, they should go to “preferred” pharmacies in their prescription drug plan and be open to mail-order. Nowadays anyone can download an app on their phone with coupons for certain medications. A Medicare coach can show you how it can make sense to use coupons for some medications in order to miss hitting the donut hole.
Extra benefits typically include dental, vision, hearing, fitness membership, and over the counter benefits. These benefits are fairly straightforward and easy to compare. For example, last year your MAPD plan may have had $1,000 of dental and it is now being decreased to $750, and the new proposed plan has $2,000 of dental benefits. Follow the same logic across the extra benefits and use this information to determine if the new plan is a better fit.
Co-payments are common with MAPD plans. If a Medicare beneficiary on a MAPD plan sees a specialist, they will likely have a co-pay they are responsible for paying. When comparing your existing plan to a newer MAPD plan pay attention to co-pays and any extra benefits the new plan has for assisting with co-pays.
Maximum-out-of-pocket (MOOP) refers to the amount of money a Medicare beneficiary could be responsible for paying. A small percentage of Medicare beneficiaries hit the MOOP, but if it does happen it is typically thousands of dollars. When comparing an existing MAPD plan to new options make sure to account for the increase or decrease of the MOOP.
Before you sign up for a Medicare Advantage Prescription Drug Plan did you ask yourself the seven questions? If not or you need helping making the comparison speak with a local Medicare specialist in your state or give us a call.
