A reader illustrates how the process of shopping for Medicare coverage is broken

Shopping for the right Medicare Advantage plan is way more complicated than it should be.

In this week’s column, Phil Moeller, the author of Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs and co-author of the updated edition of How to Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security, answers a reader question about shopping for the right Medicare Advantage plan.

While open enrollment for all Medicare coverage ended Dec. 7, there is a separate annual enrollment period for people with Medicare Advantage plans that runs from Jan. 1 to March 31. This is a good thing because shopping for the right coverage can be complicated, including making sure your preferred doctors and care facilities are included in your plan’s network of covered providers.

Occasionally, a reader’s experiences illustrate how hard this experience can be. Jeff’s story is both a cautionary tale and a tribute to one man’s vigilence:

Question

Phil:

I read some of your pieces about Medicare while in the midst of looking at changing to a Medicare Advantage plan from our somewhat costly Medigap Plan F. It costs $202 a month each in premiums for my wife and I and, of course, we still have our Medicare Part B Premium and monthly premiums for our Part D drug plans.

My approach was to see what plans were in common between all my providers, so that I could then compare those plans. But, being able to get the answer to a simple question was far from easy, or even possible. With one of our providers, for example, I called and was told to look at their website. Their website lists insurance companies, but does not distinguish between Medigap and Advantage Plans.

After calling to ask about this, I was transferred — explained, transferred, explained, transferred…transferred six times!

Finally, I was told by a representative that they would research this and call me back on with the answers. I never got a call so I called again. The representative said that he had communicated my request to his boss, who had communicated it to finance, and that someone from finance would call me back. I never got a call.

I had decided to concentrate first on our major providers, and with each one had the same basic experience. First I would be told that they accept all insurance, or again be told to see the website — explain, transfer, explain, transfer, leave message, wait for call back, no call back, call again, etc.

One thing that would be good to point out to your readers is that in checking providers, one has to check not only for the major provider but then, within that practice, individually for each of your physicians. Just because a physician “works” at a provider’s facilities does not mean that they are in the same insurance plan network.

Finally, I was able to get enough feedback from my providers to then make a spreadsheet and see what plans were worth comparing. I tentatively selected a plan, read its 280-page Evidence of Coverage document, made up a list of questions, and called the insurer — explain, transfer, explain, transfer….

This permitted me to create a 20-year cost comparison to our Medigap plan using reasonable assumptions (at present day dollars). It turned out to be a close call, but worth confirming some information with the Advantage Plan to finally decide.

I then used the insurer’s website to check further into its in-network coverage. One hospital is part of a chain that was included, but this particular hospital was not listed as a provider. An anesthesia practice told me that they accepted the plan I liked, but they too were not listed. I called the plan to find out if that was possible, for a provider to not be listed, but was told that providers must contract with the plan and are automatically listed once they do.

My planned 10 hours became more than 30 hours, offices aren’t open on Saturday, and so we missed the Dec. 7 open enrollment deadline. We’ll have to pick up on this next year with open enrollment for 2021 plans.

Jeff

Answer

How about a search tool that permitted users to enter the name of a clinician and find out what networks he/she participated in?

Jeff:

Your retelling of your experience really drives home that provider networks are the weak if not broken link in Medicare Advantage. A recent report said that physician offices spend nearly $2.8 billion a year on network inclusion and accuracy work.

The Centers for Medicare and Medicaid Services (CMS) would make a lot of people happy if it mandated that Medicare’s much- (and rightly) maligned Plan Finder must include transparent, accurate, and detailed provider network information.

Or, how about a search tool that permitted users to enter the name of a clinician and find out what networks he/she participated in?

Finally, that spreadsheet of yours sounds like a work of art!

Got a question of your own about Medicare or Social Security? Send it to askphil@considerable.com.

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