Now is the time seniors and others with Medicare can potentially save — or lose — thousands of dollars in health care costs next year by choosing a Medicare plan.
Open enrollment began Saturday and runs through Dec. 7. Whatever plan enrollees choose now — traditional Medicare, Medicare Advantage managed care plans or a Part D prescription drug plan — takes effect Jan. 1.
“Even if you are happy with your current coverage, we encourage Medicare beneficiaries to shop as they might find a new plan that’s a better fit for their budget or health needs,” said Verlon Johnson, acting regional administrator for the Centers for Medicare and Medicaid Services (CMS).
In Ohio, more than 2 million people depend on Medicare, the federal health insurance program for people 65 or older and some younger disabled Americans. All have access to Medicare Advantage plans. And increasingly, Americans and Ohioans are opting for Medicare Advantage, plans that are managed by private insurance companies to provide medical and, usually, drug coverage. All but the poorest enrollees pay a portion of the monthly premiums for the plans, and the government pays the rest.
In Ohio, 1,359,909 people used traditional Medicare as of August; 844,007 others enrolled in Medicare Advantage and other plans during the same time, according to the CMS.
Plan costs and covered benefits can change yearly.
Medicare Advantage plans vary by county. In Summit County, Medicare recipients can choose from among 42 Medicare Advantage plans that help pay for doctor visits, hospital stays and other services. All but four of those plans include some level of prescription drug coverage.
Separately, all Medicare recipients in Ohio can choose from 22 Medicare Part D drug plans, private plans that cover all or part of prescription drugs. About 83 percent of Ohioans with a Part D plan this year have access to a plan with a lower premium than what they paid in 2016, Johnson said. The cheapest monthly premium for Part D is $14.60.
Seven of the Medicare Advantage plans offered in Summit County have no monthly premium for enrollees.
The cheapest plans may look tempting to cost-conscious shoppers, said Francine Chuchanis, a Medicare ombudsman for the Direction Home Akron Canton Area Agency on Aging.
But, she cautioned, those plans can end up costing some people much more than pricier plans when they figure in deductibles, out-of-pocket caps, prescription costs and whether their doctor is included in the network.
“A plan that fits your friend, your neighbor or even yourself this year might not fit next,” she said. “This can be complicated stuff.”
New this year: ratings
Something new this year for area Medicare Advantage shoppers is a 5-star plan.
Only 14 out of 364 Medicare Advantage companies offering managed care plans with drug coverage nationwide attained Medicare’s perfect score.
The rating is based on 44 quality and performance measures, including whether a plan detects, prevents and improves the health of members, how it handles member appeals and customer satisfaction.
AultCare’s PrimeTime Health Plan was the only Medicare Advantage plan provider with prescription coverage in Ohio to earn the top rating. It has four options serving 12 Northeast Ohio counties, including Summit, Stark, Medina, Wayne and Portage counties.
“We’re so proud as an organization. You can’t believe how many people were involved to make this happen,” said Mike Novelli, a vice president of AultCare, which has been offering Medicare Advantage plans since 1997. “Now we need to get out there and educate people about what it means to be a 5-star plan.”
For AultCare, which has about 21,000 Medicare Advantage customers, the 5-star rating means it can market itself year-round, not just during open enrollment like other plans. AultCare has agreements with hospitals in most of the counties it serves, Novelli said.
For consumers, the 5-star provides a unique option: If you sign up for a different Medicare Advantage plan and don’t like it next year, you can switch to one of AultCare’s PrimeTime plans once during 2017 without having to wait for open enrollment.
Medicare designed the 5-star system to encourage enrollment in high-performing plans.
Chuchanis said she can’t remember another 5-star plan in the Greater Akron area.
SummaCare, which earned a 4-star Medicare rating, continues to be the largest provider of Medicare Advantage plans in Summit County. It has more than 24,000 members in 41 northern Ohio counties.
Other considerations
When shopping, consumers should pay attention to a plan’s star rating — particularly if it has less than three stars — but be aware that the star rating is only one of several considerations to weigh.
Chuchanis said many shoppers want to hang on to the doctors who care for them.
The only way to know whether a doctor is covered by a plan you choose — even if you’re sticking with the same plan as you have this year — is to call the doctor’s office and ask, she said.
During open enrollment, Medicare recipients are sometimes the target of scams, federal, state and local officials said.
Medicare will never contact you and ask for your Medicare number or other personal information.
If you suspect someone is using your Medicare or trying to steal your information, contact the Ohio Department of Insurance fraud and enforcement hotline at 800-686-1527 or Ohio Senior Medicare Patrol at 800-488-6070.
Amanda Garrett can be reached at 330-996-3725 or agarrett@thebeaconjournal.com.