Dear Tom and Alan:
I’ve been on the SCAN plan for two years now and am pretty happy with it.
A friend of mine is on Kaiser Senior Advantage and says I should switch to that. My premium with SCAN is $25 per month (used to be 0!) and it has drugs and transportation included.
Which one is best?
Also, my husband has a Medicare supplement plan that he likes, but he wants to change his drug plan. I know open enrollment is pretty soon, so which drug plans are best?
Tom: Wow, our first hashtag!
Let’s take the first question. In Napa County, the only Medicare Advantage plans (Part C) available are SCAN and Kaiser Senior Advantage.
Since we’re not allowed to sell Kaiser Senior products, I don’t know any details about their plans.
I can tell you that according to the Centers for Medicare and Medicaid Services (CMS), on their most recent star ratings, Kaiser received five stars (out of five) and SCAN received four and a half.
According to CMS.gov 2017 Star Ratings: “Medicare Advantage with prescription drug coverage (MA-PD) contracts are rated on up to 44 unique quality and performance measures.”
There are five categories: outcomes; intermediate outcomes; patient experience; access; and, process. Patient experience and access are given the most weight.
Al: We’re told that a plan with three stars or fewer is subject to losing some of the federal funding that keeps these plans afloat.
On the website, it says over 90 percent of MA-PD enrollees are in plans with three and a half or more stars.
An additional big plus for a five-star plan is that once a year you can enroll in the plan even if it’s not during the Annual Enrollment Period (AEP).
Tom: Since our reader was asking about the “open enrollment” period, that’s what the AEP is. Each year from Oct. 15 to Dec. 7, anyone can change their current Advantage plan or drug plan to something else.
The new plan goes into effect on Jan. 1 of the following year.
Although it can be confusing, the AEP is not to be confused with the open enrollment period of the Affordable Care Act (ACA or Obamacare) which, this year, is from Nov. 1 to Dec. 15.
Al: As to your husband’s Part D Medicare Prescription Drug Plan (PDP), he can call us (we can’t call him) to meet sometime after Oct. 15 to talk about alternatives for his plan. By that date, we will have rates and benefits for a number of different plans.
For most prospective customers we look up prescriptions based on name, dosage and frequency so we can verify how it will be covered under each plan.
Companies typically have up to five tiers: one and two are generic; three through five are brand name and specialty drugs.