Opuscula Medicare.GOV Versus Medicare Dot anything else

WE ARE NEARING THE FINAL DAYS to sign up for Medicare 2019 and the commercials are frequent.

Many of the Medicare Advantage companies advertise their wares.

However, some companies named “Medicare dot something” are licensed insurance sales companies paid by companies they recommend.

THERE IS NOTHING WRONG with these “Medicare dot something” companies EXCEPT they don’t offer a complete list.

The ONLY source of information for ALL Medicare plans is

http://www.medicare.gov

The other guys are paid by the companies they pitch to the callers.

I discovered this several years ago when I asked a “Medicare dot something” company to give me options. I had one company in mind (AvMed).

The guys who promised to tell me about ALL plans failed to tell me about AvMed since AvMed didn’t pay them.

MEDICARE.GOV, on the other hand, lists ALL plans in specific geographic areas — usually counties or parishes — and it offers

Summaries of all plans and Links to the plan’s provider.

Medicare.gov home page.

There is no trick to comparing plans, but it pays to know the documents to view.

When I shop for plans — and I do this every year — I first create a a spreadsheet — I do it on a computer, but paper and pencil work just as well — that looks something like the image below.

I list the things critical to me first.

All the information is online. (Some companies are “cheaping out” and no longer offer their documents in hard copy. Online probably is better in any event since it is more likely to be up-to-date.)

The documents you need are:

Evidence of Coverage Providers’ List Formulary (Drug List)

The Evidence of Coverage is the most important document; once approved by the Centers for Medicare & Medicaid Services (CMS), this document is cast into concrete. Unlike the Providers’ List and the Formulary, the Evidence of Coverage cannot be changed until December 31 of the following year.

Use Medicare.GOV to link to the insurance provider’s web site and then locate the three critical documents (ibid.). DO NOT SETTLE FOR A PLAN “SUMMARY.” Plan summaries basically are no more than marketing tools.

Most Evidence of Coverage documents follow, more or less , a common format. Some plans may offer a little more than others which makes a computerized spreadsheet more convenient when a row has to be added. Most lists are alphabetical.

Use the Providers’ List to find out what doctors, hospitals, urgent care centers, and pharmacies are on the insurer’s list.

Use the Formulary to see if the insurer includes any prescription drugs you take. The Formulary also tells you each drug’s TIER. The tier determines what, if any, copay will come from your pocket. You will have to go back to the Evidence of Coverage to find out the copays for each tier for 30 and 90-day supplies.

If the plan limits its Primary Care Physicians’ (PCPs) access to certain specialists — most plans do limit their PCPs — make sure the PCP you select can and will refer you to your specialists. The only way to do this is to ask the PCP’s office administrator. The PCP probably doesn’t know. If the PCP has an online presence, you might be able to email the office; that way there is a written record.

I had one company tell me that my specialist was on its Providers’ List, but then I checked with the specialist he said that was not the case. It always pays to check with BOTH the PCP and the specialist.

I seriously doubt that any “Medicare dot something” organization will be as through as you will be, especially when it come to access to specialists.

MEDICARE SUPPLEMENT PLANS

All of the foregoing is about Medicare ADVANTAGE plans.

Medicare.GOV also can help if you prefer a Medicare SUPPLEMENT plan.

The major differences, as I see it, between Advantage and Supplement plans are

* Supplement plans allow the subscriber to see any provider that accepts Medicare patients, and sans a referral from the PCP * Supplement plans cost more than Advantage plans * Many Supplement plans lack pharmacy coverage * There often are multiple Supplement plan options (A through F or more).

Firms pushing Supplement plans contend that the plan covers the insured “anywhere in the U.S.” So do Advantage plans. In fact, Advantage plans usually cover the insured anyplace in the world they may travel and most Advantage plans include pharmacy coverage.

BOTTOM LINE

When looking for ANY type Medicare plan — even original Medicare — the place to start ALWAYS is medicare.gov. It’s the only address where you know you can learn about ALL plans available in your area.

Nobody does it better.

Medicare.gov sample program listing; there were 41 unique plans flagged for comparison.

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