How can I tell if my Medicare Advantage plan is financially sustainable long-term?
Answered by 13 licensed agents
Medicare Advantage rules and funding change annually. You should look to make sure your plan is a consistently highly-rated carrier for the best safeguard against sudden plan withdrawals or benefit reductions. If they have a Star Rating that is a 4 or higher this means they will be receiving additional funds from CMS and provide better financial stability. You should also make sure to check the financial rating from A.M. Best, Moody's and Standard and Poor's and look that your carrier is A rated or higher.
If you are worried about the carrier being in the market for the long term, the larger carriers generally have more stability and are less likely to leave a market quickly.
To see if a plan is financially feasible for you, track your annual expenses. Are you paying more for drugs that are not on formulary? Are you paying for many out of network doctors, hospitals and procedures? If the answer is yes, the key to having the best financial outcome with a plan is to make sure your doctors, meds and hospitals are all in network. A broker can review your plan and make sure it is working for you.
Look at the plan’s history of stable premiums, copays, provider network, prescription coverage, and star ratings over time, not just the current benefits. Plans backed by well-established insurance companies with strong financial ratings also tend to offer more long-term stability. A local Medicare agent can help you review yearly changes and avoid plans that may look great now but change significantly later.
The simple answer is you really can’t. Medicare Advantage plans change every year, sometimes for the better and sometimes not. Premiums, copays, prescription coverage, and extra benefits can all change annually, and sometimes plans stop offering coverage altogether. The good news is that Medicare gives you the Annual Enrollment Period each year to review your coverage and decide if a different plan makes more sense for the following year. Also, if your plan ever leaves the market, you may qualify for guaranteed issue rights to enroll in other Medicare coverage without health questions.
On an individual basis, check the plans star rating and look over the insurance companies general reputation and history.
It can also be good to ask your favorite doctors office what Medicare insurance plans they like to work with. Certain plans are better in some counties/states than others. Often the doctors billing department can tell you which insurance companies are quicker to pay their bills, pass prior authorizations, and approve care.
A good way to look at it is this — you’re not just choosing a plan for this year, you’re choosing a company you may be dealing with for years to come. It’s worth looking at how long the company has been in the Medicare market, their financial strength, customer reviews, provider network stability, and whether they tend to make major benefit changes every year or stay fairly consistent. A strong, established company with a solid reputation for customer service and stability can often make your experience much smoother long-term.
I would start off by looking at how long a carrier has been in the business. UHC, Humana, Aetna, Blue have been doing this a long time even though they have withdrawn their PPO plans from some counties in the past couple of years, they still have quality products available. Ultimately, you will want to look at carriers with high star ratings and quality reviews on-line
Hard to say because these contracts are re negotiated every year unlike Medigap plans but with all that said I would choose a carrier that has a big footprint nationwide, has a track record and perhaps a flagship carrier that has cost control and doesn't give away the farm to entice people to sign up. Star ratings are also key.
Medicare offers Star Ratings that you should certainly consider. From there, your Licensed Agent can offer additional industry input and help you research the stability of the carriers offering the plans you are looking at.
It will depend on the company you have your plan with and the star rating of that company. Also the length of time the company has been in the Med Adv business and also word of mouth
Medicare Advantage Plans are run by private insurers, but you can evaluate whether it's stable, well-run and unlikely to suddenly worsen benefits or network access. Also, checking their rating based on the carrier you currently have. It's not something you personally fund long term such as investment.
