Time to Shop for New Medicare Coverage - Kraft Elder Law

The open enrollment period for Medicare plans comes a little early this year, but the decisions won?t be any easier than normal.

Pamela Yip, the excellent personal finance columnist for the Dallas Morning News wrote in detail about the decisions facing seniors this year. Here are excerpts from her column:

Listen up, seniors: It?s time to shop for your best deal on Medicare drug and health plans for 2012.

?Open enrollment is the right time to make sure your drug and health plans still meet your individual needs, especially if you?ve had any changes in your health,? said Bob Moos, spokesman for the U.S.?Centers for Medicare and Medicaid Services.

?Even if you?ve been satisfied with your coverage, you?ll want to check your options,? Moos said. ?Shopping around may save you money or improve your coverage.?

The biggest change this year is that Medicare?s open enrollment period starts next Saturday a month sooner than last year, and runs until Dec. 7. That?s earlier than prior years, when open enrollment ran Nov. 15-Dec. 31.

Any changes made during the open enrollment period will take effect in January.

The good news this year, said Moos: ?Drug plan premiums will be about the same, on average, as in 2011. In Texas, the 33 drug plans available to people in original Medicare will have monthly premiums ranging from $15.10 to $104.30.?

A growing number of people age 65 and older are finding Medicare Advantage plans to be a strong alternative to the traditional Medicare fee-for-service program.

The plans are essentially a private version of Medicare. Instead of paying beneficiaries? claims directly, the government pays insurers to oversee the health care of seniors and people with disabilities.

The plans have caught on with seniors on fixed incomes because they typically combine hospital and physician coverage with additional benefits such as prescription drug insurance, preventive medical care, dental services and vision coverage.

Enrollment in the private health plans is projected to increase 10 percent in 2012 to more than 13 million people.

?Thanks to new bargaining power gained through the Affordable Care Act, Medicare was able to ward off significant cost increases or benefit cuts for those health plans in 2012,? Moos said. ?In fact, Medicare Advantage premiums will be about 4 percent lower, on average.?

For those already on a private Medicare Advantage health plan who would like to switch back to the traditional Medicare program, the open enrollment period is also the time to do it.

Here?s how to decide whether you should change your Medicare coverage:

?Many aspects of the benefit design can change,? said Juliette Cubanski, associate director of the Program on Medicare Policy at the?Kaiser Family Foundation, a nonpartisan group that studies health care issues.

?Drug plans can change which drugs they cover, how much they charge for generics and brands, which tier they place a drug on,? such as preferred vs. nonpreferred brand.

Premiums and deductibles can also change, she said.

?Similar aspects of benefit design can change in Medicare Advantage plans,? Cubanski said. ?They have to cover all Medicare-covered benefits, but they can change how much they charge for office visits, for example.?

Determine true cost

Don?t shop on insurance premiums alone.

?The only way to determine the true cost of your drug or health care coverage is to check on other factors like deductibles, co-payments and co-insurance,? Moos said.

Although it?s important to know your monthly premium, it?s much more important if you?re on a fixed income to know what your total out-of-pocket limit is each year, said Steve Zaleznick, senior Medicare adviser at PlanPrescriber.com

?If you get sick or injured, some Medicare plans have deductibles, co-payments and co-insurance that you may have to pay in addition to your monthly premium,? he said. ?Those costs can add up.?

Check the drug plan

Make sure your prescription drug plan is still the right coverage for you.

Zaleznick said PlanPrescriber.com reviewed people?s drug use and selection process during the 2011 Medicare annual enrollment period.

?We found that the average person could save over $500 per year by switching to a drug plan that was a better fit for their particular prescription needs,? he said.

Know the good news

The health reform law is gradually doing away with the doughnut hole, the gap in Medicare drug coverage that many seniors have fallen into.

In 2012, after paying a $320 deductible, you pay a co-payment, and your drug plan pays its share, for each drug until the combined spending,?including the deductible, reaches $2,930.

Once you and your drug plan have spent the $2,930 for drugs, you?re in the?doughnut hole.

In the past, Medicare beneficiaries would have been responsible for the full cost of their drugs while in the coverage gap.

But in 2012, you get a 50 percent discount on brand-name drugs and a 14 percent discount on generic drugs.

What you pay, as well as the 50 percent discounts you receive, count as out-of-pocket spending and help you get out of the coverage gap.

Once your out-of-pocket expenses have totaled $4,700, you will leave the doughnut hole. You?ll then qualify for Medicare?s catastrophic drug coverage and will pay just 5 percent of your costs for the rest of the year.

?The price breaks for brands and generics will grow over time, effectively eliminating the doughnut hole by 2020,? Moos said. ?At that point, beneficiaries will be responsible for 25 percent of their drug bills, the share they now pay before entering the gap.?

If you have difficulty affording your medications, you may be eligible for help with costs in the doughnut hole.

?The amount of extra help depends on your income and resources,? Moos said. ?But generally, you?ll pay no more than $2.50 for generic drugs and $6.30 for brand-name drugs.

To learn more about whether you qualify for help, visit www.socialsecurity.gov/prescriptionhelp or call Social Security toll-free at 1-800-772-1213.

You owe yourself the best coverage possible, so look closely at the plans to determine if a new plan would better suit your needs.

Medicare is complicated but critical for seniors. Here are some ways you can get help:

Go to www.medicare.gov and click on ?Compare Drug and Health Plans? for a tool that will help you narrow your search. After entering your ZIP code and a list of your prescriptions, you can use the Medicare Plan Finder tool to compare coverage and out-of-pocket costs under different plans in your area. The Plan Finder also provides ratings of each plan?s customer service.

Call Medicare?s toll-free help line at 1-800-633-4227 or consult your ?Medicare & You 2012 Handbook,? which you should have just received in the mail.

Get one-on-one benefits counseling through your State Health Insurance Assistance Program. In Texas, call 1-800-252-9240.

Source: http://www.kraftelderlaw.com/time-to-shop-for-new-medicare-coverage/

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