You can make changes to your prescription and health plans once a year. These changes could result in savings on medical costs, or increased access to new benefits such as wellness visits and preventive care services. You may consider changing plans, due to change in medical condition, you have moved, or provider no longer offers services. Having an annual plan review based on your individual circumstance is important. Make sure y consider these five important factors before you change
Cost- What are the premiums, deductibles and other costs compared to your current plan? What are the yearly limits and out of pocket expenses?
Prescription Drugs- How does any change you make affect your drug plan? Are there penalties or are their specific coverage rules that apply to your prescriptions?
Doctors and Providers-Do your doctors and other health care providers accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and health care providers from a network? Do you need to get referrals?
Travel- If you plan on traveling, will the new plan cover you in another state?
Quality of Care- Sometimes cost is important, but so is quality of care. Are you happy with your medical care providers?
Before you consider any change call me, I can help you manage your change to make sure it is the best possible option for you.
5 Star Rating Program
As a part of the Affordable Care Act, the government is using a five-star rating system to help you identify high-quality Medicare plans. To rank the plans, a mix of information reported by insurers, consumer surveys, and Medicare records on more than 55 topics for plans covering health and drug services is compiled and posted on www.medicare.gov.
Plans are rated on how well they perform in these categories
1. Staying healthy: screenings, tests, and vaccines
2. Managing chronic (long-term) conditions
3. Member experience with the health plan
4. Member complaints, problems getting services, and improvement in the health plan’s performance
5. Health plan customer service
When considering providers I recommend not just considering the rating system. While it is effective, you need to also do your research and reference checking. For example, if you are considering a nursing home, you should consider; staffing, safety, health inspections for example. Make sure you visit the facility. For doctors, I always recommend getting a recommendation from a friend if possible.
In previous years plans were allowed to maintain their Medicare Advantage status despite poor quality ratings, CMS (Centers for Medicare and Medicaid Services) has proposed a rule that will give it the authority to terminate poor-performing Medicare Advantage and Part D plans that fail to achieve at least a three-star rating for three consecutive years.