SummaCare Medicare Annual Enrollment Period
Posted December 02, 2019 by Anne Armao
October 15 marked the beginning of the Medicare Annual Enrollment Period, sometimes referred to as the Annual Election Period or AEP. Most Medicare beneficiaries have only 10 weeks, from October 15 to December 7, to make changes to their existing plan. With more than 60 Medicare Advantage plans to choose from in such a short time, it’s no wonder selecting the right plan for some Medicare beneficiaries can be confusing and overwhelming. Anne Armao, Vice President of Medicare at SummaCare, a veteran of the Medicare insurance world and a native Ohioan, provides the following four tips for those shopping for a new Medicare Advantage plan or evaluating a current one.
- Prioritize what’s important to you but make sure to look at the fine print. Make a list of the most important features to use as a guide as you research your options. Many beneficiaries will select a $0 premium plan for affordability, only to find themselves stuck with copays and coinsurance at the point of care. At SummaCare, we designed our $0 premium Topaz plan so that the PCP office visits also have $0 office copays. In fact, all of our plans have a $0 PCP office visit copay. We believe that all beneficiaries should have easy access to quality primary care providers without the barrier of a copay.
Check your prescription drug copay to identify the tier and corresponding copay. At SummaCare, we are making it easy for our members to obtain their necessary medications by making our Tier 1 preferred generic drugs for 30 and 90 days available at $0 copays for the above plans. Tier 6 vaccines are also available at a $0 copay. Many of our medical offices have onsite pharmacies offering a convenient way to fill or refill prescriptions.
It is also important to check the out-of-pocket maximum cost. Out-of-pocket maximum cost refers to Medicare covered health care related expenses you pay yourself and can include items such as copays, coinsurance, and deductibles. CMS requires health plans to identify the maximum out-of-pocket cost for Medicare covered services but this amount can vary from plan to plan. If you are interested in lowering your out-of-pocket expenses, be sure to inquire about this when you shop. We are proud to keep out-of-pocket maximum costs low on all of our plans.
- Choose a high quality plan. Did you know that Medicare has developed a standardized way of measuring the quality of the Medicare Advantage plans? Medicare provides an annual Star Rating for each Medicare Advantage plan. There are more than 40 rigorous quality measures that combine to create a star rating for all Medicare Advantage plans. A total of 5-stars are possible with 5 being the highest and 1 being the lowest. Medicare uses a formula that accounts for quality metrics from the following areas to provide a star rating for each plan:
- Staying healthy: screenings, tests, and vaccines (examples include regular breast cancer screening, colorectal cancer screening and flu vaccines)
- Managing chronic (long-term) conditions (examples include tests to check the control of diabetes like eye exams, kidney disease monitoring)
- Plan responsiveness and care (examples include getting appointments and care quickly and ratings of the health plan)
- Member complaints, problems getting services, and choosing to leave the plan (examples include the number of complaints, service issues and beneficiaries voluntarily leave the plans)
- Health plan customer service (examples include making sure that appeals are done timely)
Reviewing Medicare’s star rating for your plan helps you choose plans that are high quality. We are proud that SummaCare has consistently been one of the highest-ranking Medicare Advantage Plans in our market with a 4.5 star rating for 2020.
- Look for extra or supplemental benefits. Some Medicare Advantage plans offer extra benefits that are not covered by Medicare. For example, all of SummaCare’s Medicare Advantage plans offer vision, dental, hearing aid coverage, SilverSneakers®, transportation, and coverage for home safety devices. Most of SummaCare’s Medicare Advantage plans also offer therapeutic massages, acupuncture, and a quarterly allowance for over-the-counter items. For those who prefer telehealth services, we have contracted with Teladoc® to make it easy. Our Garnet plan offers the most generous allowance of supplemental benefits among all SummaCare plans.
- Pick integrated care over big name providers. When doctors, hospitals and insurance companies do not work together to coordinate and integrate the care, the patients are often left to suffer during their most vulnerable times. Coordinated and integrated care seem so simple, but is not easily achieved if doctors, hospitals and insurance companies spend time dueling with each other. SummaCare is part of Summa Health, a high quality integrated delivery system in Northern Ohio. We dedicate efforts to work with our doctor and hospital partners help inform and design the best integrated care for our members. This is one of the main reasons that we consistently outrank our competition in quality scores and Medicare Star ratings.
If you have questions about Medicare, please call SummaCare at 330-996-8440 or (toll-free) 888-464-8440 (TTY 800-750-0750). A SummaCare Medicare Advisor is available to take your call from 8 a.m. to 8 p.m., Monday through Sunday.
SummaCare is an HMO and HMO-POS plan with a Medicare contract. Enrollment in SummaCare depends on contract renewal. Every year, Medicare evaluates plans based on a 5-star rating system.