1. Anticipated Premium Increases and Cost Impacts
Premiums and government payments to MA plans are increasing: Payments from the government to MA plans are expected to rise by an average of 5.06% from 2025 to 2026. These increased payments may lead to higher premiums for beneficiaries, affecting your overall out-of-pocket costs.
2. Plan Coverage and Benefits
Ensure the plan covers essential services and medications. Evaluate whether extra benefits like dental and vision are worth any additional cost.
3. Network and Access to Care
Verify that your preferred providers are in the plan’s network to maintain access to high-quality care.
4. Utilization Management and Rules
Many plans impose techniques like prior authorization that may restrict access to services.
5. Star Ratings and Quality
Review the CMS Star Ratings as higher-rated plans generally provide better service and health outcomes.
6. Eligibility and Enrollment Windows
To enroll, you must have both Medicare Part A and Part B and enroll during an eligible period.
7. Out-of-Pocket Maximum
Compare annual out-of-pocket maximums as lower maximums can protect from high expenses.
8. Changes for Dual-Eligible Beneficiaries
New requirements may directly affect Dual Eligible Special Needs Plans (D-SNPs).
9. Regulatory Changes
CMS has updated methodologies but has not restricted the use of AI in coverage decisions.
10. General Market Trends
MA plans are often reimbursed about 20% more than traditional Medicare, raising overall costs.
Summary of Key Precautions:
- Scrutinize total costs: Examine all costs, not just premiums.
- Assess network adequacy: Ensure access to your preferred providers.
- Understand restrictions: Know the preauthorization rules.
- Monitor plan changes: Review cost and coverage updates.
By carefully weighing these factors, you can better manage the impact of rising premiums and find the Medicare Advantage plan that fits your healthcare needs best. Have questions about this topic? Call Julio Now for expert guidance.