Medicare Advantage: Compare benefits and costs in 2010 plans

How do you compare Medicare Advantage plans? You can go to Medicare.gov and compare plans side-by-side, though not all benefits are covered. Two very important items to look at closely are:

MOOP:  annual Maximum-Out-Of-Pocket, or a cap to your co-pays each calendar year. This is important if you get cancer, because your 20% co-pay for chemo and radiation therapy will add up quickly.  Other chronic illnesses will also mean many co-pays that can add up.

HOSPITAL CO-PAY:  Your hospital co-pay can add up to thousands of dollars if you spend ten days or more in the hospital.

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Let’s compare Medicare Advantage plans in southern Arizona that include drug coverage.

LOWEST MOOP:  Health Net has introduced a $3,400 MOOP for all of its Ruby plans. Universal also has a $3,400 MOOP.

NO MOOP:  Secure Horizon Medicare Complete Plan 1 has no MOOP.  CareMore plans have no MOOP.

LOWEST HOSPITAL CO-PAY:  CareMore plans have a $100 per day co-pay for days 1-5. You don’t pay after day 5. 
Health Net Ruby 3 is next with a flat co-pay of $695 per admit.
Humana Gold Plus HMO-POS is next with $195 per day for days 1-7, for a possible 7-day (or 10-day or 20-day) cost of $1,365.

HIGHEST HOSPITAL CO-PAY: Universal’s Any Any Any plan at $300 per day for days 1-7, for a possible cost of $2,100.
Health Net Ruby 1 and 4 are next with $200 per day for days 1-10, for a possible cost of $2,000.  But if you’re in the hospital just two days you’ll pay $400.

PREMIUMS:  Many people look at this first and look no further when they see a premium.  But you should study all the co-pays to see if paying a premium might be worth lower co-pays or extra benefits in the plan.

Secure Horizons HMO plans 1 and 3: $0 premium 
Humana  HMO-POS: $0 premium
Health Net Ruby 4:   $0 premium (but a $265 deductible)
Health Net Ruby 1:   $36/month
Humana local PPO:  $51/month
Health Net Ruby 3:  $59/month premium (includes $1,000 dental and $400 vision benefits)
Universal Gold:   $39/month (This is a private-fee-for-service plan, no network.)
Universal Silver:  $69/month  (private-fee-for-service.)
Humana Regional PPO: $88/ month  (This is very high, but it may be your only choice in some locations.)
Universal PFFS:   $49/month    (This is very high, but it may be your only choice in some locations.)

RIP-OFF PREMIUMS: 
Humana PFFS plan:   $137/month 
Humana Regional PPO: $147/month

Why are these a rip-off?  You can get a Medicare Supplement for these premiums and get much better coverage.  I don’t know how or why these companies are allowed to charge such premiums.  Unfortunately there are hundreds of people who enrolled in these plans several years ago (when the premiums were $0 or $24) who do not realize they can and should switch coverage.  If they can afford to pay $137 per month, they can afford – and should get –  a Medicare Supplement.

ARE YOUR DOCTORS IN THE NETWORK? Another detail that is critical to your review of a plan.  Are the doctors you want to see, and the hospitals you want to use, in the plan network?

DRUG COVERAGE:  Just one more (very important) thing to consider when choosing a Medicare Advantage plan.  The fact that these plans include drug coverage for no premium, or a low premium, makes Medicare Advantage very attractive.  But you must look at what your co-pays will be in any plan you are considering.  An expensive drug you take may be a tier 2 on one plan and a tier 3 on another plan.  This means a co-pay of around $40 for tier 2 versus $70 per month for tier 3.  Or, your expensive drug may not even be on one plan’s formulary. You must look closely at the drug coverage.

So how do you pick a plan?  It depends which benefits are most important to you.

• Do you insist on a $0 premium plan?  Each company offers a $0 premium plan, but you will pay for this with certain co-payments.
• CareMore will have by far the lowest co-pays for hospital stays, doctor visits, diagnostic tests, and outpatient surgery.  But it will have a very limited network this year. 
• If cost is your main concern, CareMore will be your choice.
• If having the possibility to go out-of-network for hospital services, you should look at Humana’s PPO or HMO-POS. 
• Secure Horizons’s Plan 3 is an HMO with no referrals required and the Passport program which allows you to use Secure Horizons contracted doctors across the country.
• Universal’s Any Any Any plan is the only private-fee-for-service (no network) plan that is being actively marketed this year.

 Confused?  You are not alone. Because the plans offer one good benefit, but trade this off against other not-so-good benefits, it is a good idea to discuss the plans with someone who is familiar with all the details. If you are an informed consumer, you will make a good choice for yourself.

During the Open Enrollment Period (January – March) you can change to another Medicare Advantage plan or go back to Original Medicare and pick up a stand-alone Part D  plan.

Tags: arizona, Medicare, Medicare Advantage, medicare arizona, Medicare help, Medicare Supplement, medicare tucson