Medicare open enrollment: How can I find a better plan?

Medicare open enrollment for 2013 begins today, October 15, and runs through December 7. Pay attention to it, Medicare people. Your pocketbook could depend on it. Daily for the next week, and at regular intervals through the end of open enrollment season, I'll be answering some of your most frequently asked questions about Medicare, starting with this one:

Q. My wife and I are not happy with our current Medicare Advantage policy. We have to get a referral for almost everything, there's absolutely no dental coverage, and the choice of eye doctors is very limited. What would be a better option, since we will be able to change our coverage in October?

A. You are already somewhat ahead of the game in that you (a) realize you have a Medicare Advantage plan, not a Medicare supplement and (b) understand that you can switch to another plan during fall open enrollment.

That's not always the case. Nearly one in four Medicare recipients isn't aware there's an annual open enrollment period, according to a national survey just out from the Kaiser Family Foundation.

Even people who are perfectly happy with their current Medicare Advantage or Medicare prescription drug plans should review their coverage every year, because plans can change: doctors come and go, premiums increase, drugs come off the preferred list, or vice versa. In fact, I notice your current plan will have another name in 2013 (I can tell it's the same one because the Medicare number of the plan isn't changing).

OK, so here's what you do. Go to Medicare.gov, Medicare's consumer website, and click on "Find health & drug plans" in the big yellow box near the top. Following the prompts, enter your zip code and other information (including the drugs you regularly take, if any).

Eventually, you'll be shown a "summary of search results." Click on "Medicare Health Plans with drug coverage" to see a list of full-service Medicare Advantage plans. (A few days ago I explained how to conduct this same exercise for Part D prescription drug plans.)

I ran this search using a zip code from your county of residence in a southwestern state and by golly, you're right; your current plan has no dental or vision coverage.

The good news, however, is that there are two other plans available in your area that do offer vision and dental, as well as limited hearing coverage. Both from the same carrier, they have very high Medicare quality ratings of 4.5 out of a possible 5 stars. That means the plans are getting an extra quality bonus from Medicare that they are using either to add optional benefits (such as vision and dental) or to reduce the overall cost of the plan to members.

One of the plans charges no extra premium beyond your regular Part B premium. The, other costs an extra $25 a month. In return, it has slightly lower out-of-pocket costs for prescription drugs and medical services. And both have lower out-of-pocket costs than your current plan. Moreover, these two plans have an annual cap of $5,000 on your out-of-pocket medical costs, versus $6,700 for your current plan.

The one caveat is that these two plans do not have a national pharmacy network like your current one does, meaning that you'll need to fill your prescriptions locally.

What about doctor availability? On the Medicare site you can directly compare up to three plans, and when I selected your current plan and these other two plans, I saw that your current plan says it has 1001-1500 "physicians and providers," compared to 4001-5000 for the other two plans. For each plan you can click on "View provider and physician network website," which takes you away from Medicare.gov and onto the plan's own website, where you can search its provider directory to judge for yourself whether it has enough doctors to meet your needs.

Here ends the lesson on why it pays to review your coverage every year.

For more information, see our Health Insurance Buying Guide as well as rankings of health insurance plans.
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—Nancy Metcalf