For Medicare beneficiaries willing to play the managed care game, life has never been sweeter. Or offered so many options.
Next year, more than a dozen Medicare HMOs, now known as Medicare Advantage plans, will be available in the Tampa Bay area. Nearly all will include the more generous drug coverage being introduced by Medicare in 2006.
For people who like a little more control over their choice of doctors and hospitals, there will also be a wider selection of Medicare PPO plans than in the past. A couple of these plans, which allow members to use medical providers outside the network with a higher copay, will even be available in Citrus County, which is still lacking a Medicare HMO alternative.
One important thing to remember: People who enroll in a Medicare Advantage or PPO plan should not enroll in a stand-alone drug plan.
Medicare Advantage benefits vary widely, depending upon the sponsor, the member's county and the specific plan. Only a couple of the Medicare Advantage plans charge a monthly premium; the rest are free. Several even give members a full or partial rebate on their Medicare Part B payment of $88.50.
Most plans let seniors and those who are disabled see their primary care doctor with no copay and offer a free annual physical. Copays for hospital stays can range from zero to $200 a day, depending on the plan.
Be aware that predicting copays on your prescriptions can be tricky. Each plan has its own formulary, with drugs grouped into tiers with corresponding copays based on their cost. Higher-priced generics will not necessarily be in the lowest-copay tier. Figuring out the best plan for your needs will require patience, a list of your prescriptions and a call to 1-800-633-4227.
(Companies that are offering Medicare Advantage programs with no drug benefit said they are responding to seniors who want no part of the voluntary new program, even understanding they will have to pay a penalty if they sign up for the benefit after the initial enrollment period.)
Seniors who are currently enrolled in a Medicare Advantage program have the option of remaining in the same plan. They will be receiving a letter from the plan sponsor, comparing next year's benefits with 2005. If they are satisfied with the coverage, they can opt to stay with the same plan without doing a thing.
