Medicare Advantage plans in Marin are actually pretty great. You hear a lot of horror stories associated with such plans including high copay, high deductibles, narrow networks, and denial of care. I will give you comfort based on my first-hand experience and my analysis that none of that holds true for Marin County.
So, how do you select a Medicare Advantage plan?
You select it in a very similar fashion as if you were buying a specific car. Let's say you have your eyes on a Honda Accord. So, how do you buy it? You simply select the dealer or platform that offers the best price on that Honda Accord.
Selecting a Medicare Advantage plan works the same way. Within the above metaphor just replace Honda Accord with the Meritage Medical Network and replace dealers with insurers. And, you got it. It is as simple as that.
If you buy a Medicare Advantage plan you essentially buy into the Meritage network. The insurers contract with Meritage to deliver healthcare services. Meritage defines who are the "in-network" doctors. Don't worry about narrow networks. Meritage network includes 2,100 local physicians in Marin, Sonoma, Napa, Solano, Fresno & Madera counties. That's a ton of doctors. Also, the Meritage network gives you access to excellent hospitals including Marin Health, and UCSF (ranked as one of the best hospitals in the country).
I "bought" into the Meritage network for a few years through three different insurers, and never had any problem finding pretty great doctors, specialists, etc.
Thus, regardless of the insurer you choose, you are going to get the exact same healthcare services because they all have to contract with Meritage when issuing a Medicare Advantage policy. In other words, all the qualified insurers will offer the exact same in-network set of providers because that network is Meritage.
Given that the healthcare services are identical, you obviously have to look at the price you will pay for such identical services.
However, the first thing you should do is check with Meritage who are the insurers that will be contracting with Meritage for the 2024 calendar year. That short list of qualifying insurers can change yearly. I did contact Meritage. And, they gave me their 2024 list of insurers:
- Alignment Health Plan
- United Healthcare AARP
- Western Health Advantage
The above is critical because when you explore plans using Medicare.gov it does not make that distinction. For instance, if you type your Marin zip code Medicare.gov will select Aetna Medicare Advantage plans for you. Meritage has kicked Aetna out of its network at the end of 2022. If you selected Aetna as your insurer, it would be a terrible mistake. You just about could not go to any doctor in Marin. And, you would be forced to go to San Francisco; as Aetna I believe is still part of the Brown & Toland Medical Group network that covers the City. You really don't want to do that.
So, what are the different prices that the four qualifying insurers charge for the same in-network healthcare providers at Meritage?
The price you pay for a healthcare network like Meritage is a little bit more complicated than the price you pay for a Honda Accord. So, the table below itemizes the main components of that price.
When you read criticisms regarding Advantage plans having high deductibles and copays, that certainly does not apply to the above plans offered in Marin County.
The most important figure in this table is the first one: the maximum out-of-pocket limit for the year (highlighted in yellow). That pretty much sums up your total exposure to unforeseen large medical bills (hospital copays, etc.). I benchmarked this maximum against several Medi Gap policies (supplemental policies tagged on original Medicare) for our area. And, the Advantage policies were typically associated with lower maximum out-of-pocket than the Medi Gap policies. Two such policies were with UnitedHealthcare and one with Humana. They all charged a reasonable monthly premium of around $125 (still a lot higher than the mentioned Advantage policies that charged between $0 to $35 a month). They all had various levels of copay defined as percentages instead of low fixed dollar amounts. But the crucial point was their respective yearly maximum out-of-pocket limits. The best plan had a limit of $3,470.The second one has a limit of $6,940. And, the third one had no upper limit! That latter one is a genuinely dangerous policy that exposes you to undue risk if you run into staggeringly high hospital costs.
In other words, if you go for a Medi Gap policy the costs or prices you incur are way higher than for a Medicare Advantage plan. Ok, with a Medi Gap policy, you have more access. But, that access is costing you a lot more. And, Meritage has an excellent network of doctors. So, do you really need to pay that much more for the extra access that you may not necessarily need?
Just to clarify whether you get a Medi Gap (supplemental policy to original Medicare) or a Medicare Advantage plan, you still will incur the Medicare premium of $174.70 in 2024, up from $164.90 in 2023. These premiums can be substantially higher for high-income earners.
Back to the Medicare Advantage plans, which one do you select? Ok, based on the 2024 pricing this decision is really easy. Alignment is by far the most cost-efficient.
I did not include all the relevant information. Inpatient hospital copays are quite complicated with different tranches for different numbers of days. However, on that count Alignment was also the lowest-cost provider.
How about drug, dental, vision, and hearing
These are all included within a Medicare Advantage policy. That's great. But, watch out often their respective coverage are not so great.
Personally, I have never worried about drug insurance policies because I found a better alternative at no cost the Easy Drug Card. To get the maximum discount using this card, go to a Safeway pharmacy. I have used it for a few years, and most often I get a lower drug price than my regular drug insurance.
Maybe Humana has better drug coverage than Alignment. But, it should not make any difference in your decision to go with one vs. the other.
Based on my firsthand experience all dental plans included within these Medicare Advantage policies are equally terrible. None of them covered a decent amount of dentists in Marin, if any. Given that, brace yourself for having to buy separate dental insurance. Most policies range from $35 to $65 a month.
Vision is ok. Most Advantage plans include a pretty decent vision policy with a major vision insurer such as VSP and others. These provide good coverage for exams, glasses, and contact lenses.
Hearing including hearing aids
All right this one is tricky. As you may know, hearing aids cost a fortune (good ones run $5K to $7K). If you need hearing aids in 2024, you will have to study the fine print on the relevant coverage way beyond just the summary information provided at Medicare.gov. Based on secondhand knowledge, I understand Humana was offering very generous coverage and Alignment very little. Yet, on the Medicare.gov summary, it says Humana is associated with a $799 copay and Alignment $0 copay. You can't trust these figures. You will have to dig deeper into these actual policies at the respective insurer's website to truly understand what the deal is.
If Humana's coverage is still way better than Alignment on this one count alone, this could easily persuade you to go with Humana. The difference between the two insurers could easily be $5,000 to $6,000.