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NEWSLETTER: Medicare Advantage Special Enrollment Enables Seniors to Shop for Quality Coverage

The nearly 24 million seniors enrolled in Medicare Advantage (MA) have until March 31, 2020, to compare coverage options and switch to another Medicare plan if it better fits their health needs.

Why would seniors want to switch MA plans?

About 90 percent of MA enrollees* are happy with the coverage and care they receive. Yet everyone enrolled in MA has the option to switch to a different plan—perhaps to one that offers them higher quality coverage and care.

How do seniors know if another MA plan would provide better quality coverage and care?

Quality star ratings can help consumers compare MA health plans. Medicare.gov makes quality star ratings and other comparison factors – such as network, pricing and performance in treating certain conditions – publicly available for just this purpose. Through March 31, seniors enrolled in an MA plan can check out these details and opt for a higher quality MA plan that fits their needs. See how MA prioritizes quality coverage.

In choosing to switch MA plans, what factors should seniors consider?

Seniors should compare five factors of MA plans to choose the one that fits their needs the best:

1. Quality Star Rating

Find the highest quality plans available on a scale of one to five, with five being the highest. Use the Plan Finder tool on Medicare.gov to compare star ratings of MA plans.

2. Ability to Treat Specific Conditions

MA star ratings are based on 46 measures, including quality of coverage and care for chronic conditions. Look at how each MA plan fares in treating specific conditions.

3. Prescription Drug Coverage

Many MA plans offer prescription drug coverage at no additional cost. Check to see which MA plans covers the prescriptions that matter most.

4. Network of Doctors, Clinics and Hospitals

Ensure hospitals and clinics are covered. MA plans publish directories that list the doctors, clinics, hospitals and surgery centers in network, often with information on the distances to these locations.

5. Actual Out-of-Pocket Cost

In addition to considering a plan’s premium, deductible, coinsurance and spending cap, use Plan Finder’s prescription drug cost estimator to calculate out-of-pocket drug spending. All MA plans cap out-of-pocket spending. See how MA saves seniors, taxpayers and the health care system.


By considering these factors, seniors can confirm that they have chosen the best MA plan for their health care needs. And if they want to shop around, they have until March 31 to make a change.

The flexibility to change coverage in the first three months of the year is just another way that MA plans offer seniors a higher value experience than traditional Medicare.  See why seniors are more satisfied with their MA plans than those in traditional Medicare.

NOTE: Only seniors who are already enrolled in an MA plan can switch coverage during this time. Seniors enrolled in traditional Medicare who are interested in enrolling in an MA plan must wait until fall open enrollment to change coverage or apply for a special enrollment period with CMS.

 

Want to learn more about Medicare Advantage?
Reach out to ACHP Policy Director Michael Bagel.


*Satisfaction numbers based on Morning Consult Poll. November 28-29, 2018. http://bit.ly/2NBprse