Hey Medicare Nation!
Medicare has announced the 2017 "5 Star Plans."
What are 5 Star Plans?
Medicare rates all health and prescription drug plans each year, based on a plan's quality and performance. Medicare Star ratings will help you understand the job a plan is doing.
There are 2 main types of Star Ratings:
1. Overall Star Rating that combines all of the plan's scores.
2. A Summary Star Rating that focuses on a plan's medical or prescription drug services.
A few areas Medicare reviews for these Star Ratings include:
1. How plan members rate their plan's services and care.
2. How well a plan's network of doctors detect illnesses and keep members healthy.
3. How well a plan helps it's members use recommended and safe prescription medications.
A plan can receive a 1 to 5 Star Rating.
5 Stars is Excellent
4 Stars is above average
3 Stars is average
2. Stars is below average
and 1 Star is poor.
You can only switch to a 5 Star Rating Medicare Advantage Plan or a 5 Star Stand-alone Prescription Drug Plan, that is available in your area.
You can only switch to a 5 Star Medicare Advantage Plan, Medicare Cost Plan or Medicare Prescription Drug Plan once from December 8th to November 30th of the next year.
Once you use your election to enroll in a 5 Star Plan, you cannot use it again.
If a Medicare Advantage Plan or a Stand-Alone Prescription Drug Plan has received a 5 Star Rating from Medicare, it doesnot mean you automatically go out and enroll in the 5 Star Plan.
That 5 Star Plan may not fit your unique needs!
The option is available..... if you need it!
Some people enroll in a Medicare Advantage Plan during the Annual Enrollment Period, and only switched plans because they received an incentive from the new plan.
Ex: Your neighbor "Phil" tells you he is on the greatest Medicare Advantage Plan. He receives $30 in "Bandaids" from his plan every month. He tells you to "switch" plans so you can get $30 worth of over-the-counter supplies every month. Phil hands you his "Agent's" card.
You call Phil's "Agent," who gladly comes out and enrolls you into the same exact plan that Phil has. The plan goes into effect January 1st. You call your Primary Doctor on February 6th for an appointment because you think you have the flu.
The secretary advises you that Dr. Jones does not accept the new plan your on. What? You didn't check to see if your Primary Doctor accepts the new plan? Phil's "Agent" didn't check to see if your Primary Doctor was in the new plan's network?
Sorry......you should have done your due diligence. Now you will have to "remain" on this plan until the next Annual Enrollment Period. You are "locked-in," until October 15th.
Maybe you were better off on the plan you originally were on.
In this example, you may have another option!
You find out in January, that XYZ Medicare Advantage Plan has a 5 Star Rating in your area. You can look up the XYZ Plans and determine if one of their plans accepts your Primary Doctor in their network. Check the co-pays, co-insurance and deductibles on the new plan. Check that all your prescription drugs are in the new 5 Star Plan's formulary.
If you like what you found out about the 5 Star Rating Plan that is available in your area, you are allowed to "switch" one time from the Medicare Advantage Plan you are stuck on, to the 5 Star Rating Plan available in your area.
Once you make the election to switch to the 5 Star Plan, you cannot enroll into another plan - whether it has 5 Stars or not.
Only a criteria that fits a Special Election Period will be allowed.
Look on the www.Medicare.gov website for the list of Special Election Period examples.
The 14 Medicare advantage Plans that received "5 Star Ratings" for 2017 are:
Company Name Service Area
1. KS Plan Administrators, LLC - 4 Counties TX
2. Kaiser Found. HP, INC 31 Counties CA
3. Kaiser Found. HP of CO 17 Counties CO
4. Kaiser Found. of the Mid- D.C. & Atlantic States 11 Counties MD 9 Counties VA
5. Tufts Assoc. HMO 10 Counties MA
6. BCBS of MA HMO Blue 11 Counties MA
7. Group Health Plan (MN) 87 Counties MN 8 Counties WI
8. Aultcare Health Ins. Corp 12 Counties OH
9. Physicians Health Choice TX 19 Counties TX
10. Gundersen Health Plan 1 County IA, 8 Counties WI
11. Optimum Healthcare Inc. 25 Counties FL
12. Kaiser Found. HP of NW 9 Counties OR 4 Counties WA
13. Sierra Health & Life Ins. 1 County CO, 1 County KS, 2 Counties MA, 3 Counties MD. 1 County MI, 2 Counties NJ, 2 Counties PA, 2 Counties TX, 1 County in VA
If you live in the service area of the above 5 Star Rated Plans, you should go onto the Medicare.gov website and compare the 5 Star Plan to the Plan you are currently on. Make sure your doctors are in the network. Make sure ALL your prescription drugs are covered in the formulary. Look at the co-pays, co-insurance and any deductibles.
Make sure the "5 Star Plan," is worth "switching" too!
Just because it was given a 5 Star Rating from Medicare, doesn't mean the plan will automatically be the best choice for your unique needs.
Do your Due Diligence!
You can check the Medicare.gov site for any 5 Star Prescription Drug Plans in your service area and Medicare Advantage Plans that are health plans only and do not offer prescription drug coverage on that particular plan.
You can also listen to episode MN061. I give you information on the Medicare Advantage Disenrollment period and information on Special Need Plans.
You don't have to be "stuck" on a Medicare Advantage Plan that doesnot suit your needs.
This is the time of year to make changes. Make sure you switch to a better plan this time!
Send them to Support@TheMedicareNation.com
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Have a happy, peaceful & prosperous week!