How does Medicare.gov rank the plans in your area?
This is the fourth in this series. To start at the beginning, go to 5 Questions to Ask Before Enrolling.
Wouldn’t it be nice if there were an unbiased source that would give you a list of all plans in your area and then put the plans in order of which plan is likely to be best for you?
Without a crystal ball, selecting the absolute best policy for you is not possible. However, the tools on Medicare.gov will usually point you in the right direction. You will still have to do some of the work and make some educated guesses, but Medicare.gov can do a lot of the number crunching and heavy lifting for you.
You will save a lot of time by using the list you created when you answered the question: Which policies include your prescriptions on their formulary (list of covered drugs)? This list is the result of an attempt to rank the Prescription Drug Plans and Medicare Advantage Plans in order of what your overall costs will be (unless you changed the default sort order). These estimated overall costs include the monthly premium for your policy plus an estimate of what you will be responsible for in copays and other cost shares you will be responsible for.
(If you do not have your list, create one by following the directions in the previous post even if you do not take any prescriptions. If you do not have any prescriptions, enter the name of a low-cost generic drug like “Lisinopril” when asked. If you don’t enter any drugs, the system will use a national average for prescription drug costs when ranking the plans. The national average is around $3,000 per year.)
There are three components of the overall costs for these plans. The first is the monthly premium for the policy. Since the premium cannot change in the middle of a calendar year, this part of the calculation will be accurate. The second component is your share of the cost for prescription drugs. This is likely to be accurate, unless the list of drugs you take changes. The third component is not likely to be accurate. The estimated health costs are based on a national average of copays and other cost shares for all Medicare beneficiaries including those in their 80s and 90s.
If You Decide to Enroll in a Medicare Supplement Plan
You will likely need a standalone Prescription Drug Plan. If you have your list, choosing one is easy. By default, Medicare.gov will rank the plans in order of projected overall costs.
This equation used to project your overall costs for Prescription Drug Plans only involves the monthly premium plus copays and other cost shares. So, it is likely to be accurate. Just make sure that all your drugs are on the formulary and there are no drug restrictions. See previous post for more information on these details.
If You Decide to Enroll in a Medicare Advantage Plan
For the purposes of this post “Medicare Advantage Plans” and “Medicare Health Plans” mean the same thing.
The plans listed on top of the “Medicare Health Plans with Drug Coverage” section or the “Medicare Health Plans without Drug Coverage” section are the ones most likely to meet your needs. By default, the one with the lowest projected overall cost will be listed on top.
Medicare Health Plans include health coverage. So, they are ordered by “Estimated Annual Health and Drug Costs.” However, the costs listed here are not likely to be close to what you will actually pay.
The estimated health costs are based on a national average of the copays and other cost shares for all Medicare beneficiaries including those in their 80s and 90s. If you are healthier than the average 80-year-old, your health care costs will likely be much lower than the average.
Although the system isn’t perfect, using this tool on Medicare.gov makes it easy to generate a list of plans to investigate further. You can print out a list of plans to ask an agent about. You can also click the name of the plans you are interested in to find the links to their websites and other contact information.
Not knowing exactly how much you will spend in copays for health care may mean that the absolute best plan for you won’t be listed first, but the top three are all likely to be good solid options.
Hold on to this list. If you decide to enroll in a Medicare Supplement Plan, you will probably need a standalone Prescription Drug Plan, the PDP at the top of the “Prescription Drug Plan” section will be the best plan for you unless your prescriptions change. If you decide to enroll in a Medicare Advantage Plan with built in drug coverage, one of the plans near the top of the “Medicare Health Plans with Drug Coverage” section will almost certainly be the one you should choose.
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To start at the beginning of this series click here.