Over the last few months, it seems as though every time I visit the Medicare Plan Finder, something has changed – an interactive map, different fonts and layouts, new filters and more. However, there is one change that rises to the top of my list as being the most significant and there is still one big, burdensome negative that continues to be overlooked.
The biggest plus
What do I believe is the most significant addition to the Medicare Plan Finder? Many might think this would be the change in the way the plans are listed on the results page. When introduced, the Plan Finder listed plans in order of lowest premium. Zero-premium plans floated to the top, even though the costs were likely higher than with other plans. There was an option to search by “lowest drug+ premium costs” but it’s doubtful everyone made that change. Now, plans with the lowest total costs appear first. Yes, that is an important change but not number one on my list.
The most significant improvement in my book is the addition of plan limits that apply to preferred provider organization (PPO) plans. Your response, “What?”
Plan limits are the rules those enrolled in Medicare Advantage plans (enrollees) must follow in order to receive services. There are three.
- Plan limits: The plan may specify a certain number of visits or a time limit.
- Physician referral required: The primary physician allows or instructs the enrollee to obtain an item or service from another physician or provider type. In some cases, depending on the plan’s rules, a network physician, other than the primary, may also make a referral. Without that referral, the plan may not pay for the services.
- Advanced plan approval required: More commonly known as prior authorization, this is a process through which the physician or other healthcare provider must obtain advance approval before the plan will pay for the service. If the plan does not approve the physician’s request, the enrollee either does without the service or pays for it privately.
Why do I believe this change is such a big deal? The initial versions of the Plan Finder listed limits for health maintenance organization (HMO) plans but not for PPOs. To the uninformed, because no limits were listed, it looked as though PPOs did not have any rules. How great was that, no rules! PPO plans allow flexibility to see out-of-network providers so referral rules don’t apply. However, just as with HMOs, a PPO can have plan limits and prior authorization requirements.
As good as this change is, it could be better. To learn about the applicable rules for a service, you have to click on each link. For many plans, that would be 20 or more clicks to discover that there are prior authorization requirements for chemotherapy, diabetic supplies, x-rays, in- and outpatient hospitalization and more. If you choose to print the “Plan Details” report with all the links expanded, that would be 40-50 pages. Perhaps, the Plan Finder team could use little icons next to each service to identify plan limits, referral or prior authorization requirements. That’s the way the Legacy Plan Finder handled it.
Choosing the right Medicare Advantage plan takes going beyond the premium and benefits to see how the plan will work. You need to click the “limits apply” links and get the facts. If a referral would be necessary to see an important physician or there are limits or prior authorization rules on relevant services, a plan might not work.
The biggest minus
There have been improvements; however, one big minus still exists. The Plan Finder allows an anonymous search, one that is not connected to anyone’s mymedicare.gov account. However, leave the site and everything is lost. The only way to save information about drugs is in a mymedicare.gov account. To set one up takes a Medicare number.
This creates big concerns for two groups. Those approaching age 65 and getting ready to enroll in Medicare will need to investigate plans during their Initial Enrollment Period. Those over 65 who delayed Medicare because they had employer group coverage will also need to do research. In both cases, because they are not yet enrolled, they don’t have a Medicare number. They won’t be able to set up an account and save information. If they don’t find the best plan and PDF or print all relevant information in the first visit, they will have to start over from the beginning. Re-entering medications is no big deal if you take one or two. However, the burden and possibility for mistakes increase with each additional medication.
The Medicare Open Enrollment Period begins October 15. The new features should help beneficiaries find the best drug or Medicare Advantage plan and understand the plan’s rules before enrolling. As for those not yet enrolled, they should set aside time to do their plan research, knowing that they may have to start from scratch more than once.