Comparing CA Medicare Advantage Plans for 2016 & 2017

CA Medicare Announcement, Resources

Medicare Advantage Prescription Drug Plans (MADP’s) also known as Part C are offered by insurance carriers and provide both your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). These Plans reduce your cost exposure of original Medicare while providing equivalent benefits at minimum, most plans significantly enhance coverage. MADP plans are available in most counties in Ca and often have low or zero premium HMO Plans. Aetna’s Medicare Choice Plan (PPO) has been successful in San Diego County for 2016 and has announced Plans to offer a new PPO for 2017 in Los Angeles, Riverside & San Bernardino Counties. Although the PPO Plans are not zero premium they are generally less than half of the cost of a quality Medicare Supplement and Prescription Drug Plan. Three major advantages with the PPO Medicare Advantage plan:

  • The network is substantially larger than the HMO provider networks
  • The Plan doesn’t require the insured member to obtain a referral from their Primary Care Physician (PCP) to see a specialist
  • The insured Member can see non contracted PPO providers, although he/she will pay more in doing so: for example 40% of the cost instead of a $10 copayment to see your PCP.

On the other hand, if an insured member has a Medicare Supplement than he/she can obtain care from any doctor that accepts Medicare. It’s not necessary to go to a doctor that is contracted with Aetna, Anthem Blue Cross or Blue Shield of Ca just because you have their Medicare Supplement Plan. The only question is if the provider is contracted with Medicare and then if he/she accepts Medicare assignment, as some supplements pick up the “excess charges” if they don’t.

All Medicare Advantage Plans limit your cost sharing to no more than $6,700 per year but many are significantly less. When selecting a Medicare Advantage Plan it is necessary to look at your MOOP or Maximum out of pocket amount as well as the insurance carrier’s formulary. It makes no sense to save $5 on your PCP copayment, only to latter find out that your $100+ name brand drug isn’t on your plans formulary list.  Have your agent run a prescription drug report as well as a provider finder search to see if your doctors are members. Unlike a PPO Medicare Advantage Plan, if you have a HMO your doctor and specialist Must be part of the same Medical group. Just because they are both part of the plans network you can’t get a referral if they aren’t part of the same Medical Group.

Open Enrollment begins October 15th and ends December 7th for a January 2017 effective date. Depending on your circumstance such as moving out of your current plans service area you might be eligible for a Special Enrollment Period (SEP) to make a plan change.