Understanding Seniors’ Choices in Medicare Advantage

Excerpt

Several years ago, a family member asked me to help with decisions about her Medicare coverage. Even though I am a general internist who studies health policy, the complexity of this apparently straightforward task surprised me. Between Part D and Medicare Advantage (MA) plans, there were dozens of options available. Identifying the best one required a thorough understanding of her medical conditions, current physicians, regular medications, retirement savings, and income. Premiums were straightforward to understand, but predictions about the amount of physician copayments or the likelihood of incurring a hospital deductible were more uncertain. Traditional Medicare offered unfettered choice of physicians, but no cap on out-of-pocket spending. In contrast, MA plans offered an out-of-pocket spending cap but constrained the network of providers. No single Part D formulary included all of my relative’s medications in its preferred tier. Only after many visits to Medicare’s website and careful inspection of insurance plan directories did we reach a tentative selection. …