Now Is the Time To Weigh Medicare Options
Jim_Higgins
http://www.nytimes.com/2009/10/31/health/31patient.html?_r=1&hpw
MEDICARE recipients, it�s your turn.
For the last few weeks, my Patient Money colleague Lesley Alderman and I
have been giving advice on how to navigate the open enrollment season
for employee health benefits. But Medicare enrollees must also do this
annual drill, and in some ways their task can be more complicated.
While employees now typically face a dwindling number of options,
Medicare recipients may have the opposite problem � a potentially
overwhelming welter of choices. They may need to sort through dozens,
even hundreds, of choices during the annual enrollment period, which
runs Nov. 15 through Dec. 31.
Those already enrolled in Medicare, of course, might not need to do
anything. Assuming the coverage they have now is not changing, and it�s
working for them, they can probably stand pat. That might be
particularly true for the 35 million people whose main coverage comes
directly through the government. In that case all they may need to worry
about is their Medicare D prescription drug plans provided by private
insurers, if they have such coverage; about 17.5 million of these people
in traditional Medicare have the separate drug coverage.
But as I explain below, there are various reasons that staying put might
not be a good idea. And making a change means coming to grips with an
array of Medicare options that has been expanding at a bewildering rate
in the past decade.
There is the traditional Medicare A, which covers hospitalizations and
is provided at no charge to enrollees, and Medicare B, which covers fees
from doctors and other health care providers and requires a monthly
premium. (Because there will be no Social Security cost-of-living
increase in 2010, premiums for most current B enrollees will stay the
same as for 2009, at $96.40 a month. However, most new enrollees will
pay 15 percent more than that, $110.50 a month.
Seniors can also choose from a vast number of specialized plans from
private insurers. There�s the Medicare D drug coverage, for example. But
there are also fuller private-carrier packages called Medicare
Advantage, which often bundle Medicare A and B with a drug plan, along
with extra benefits like dental, vision and wellness coverage.
Each annual enrollment season you can change from traditional Medicare
to a Medicare Advantage plan or vice versa. You can also add, change or
drop a Medicare D plan. Keep in mind if you don�t sign up for Medicare D
when you are eligible and you don�t have other creditable prescription
drug coverage, you will be assessed a 1 percent penalty per month if and
when you do sign up. This year�s annual Medicare enrollment period may
be particularly tricky for some people. Because there are so many
Medicare Advantage options available, the Center for Medicare and
Medicaid Services � the agency that runs Medicare � eliminated about 18
percent of the Advantage plans, either because they were similar to
other plans offered by the same company or they had very few members.
(Even with those cuts, thousands of other Advantage plans still exist.)
As a result, an estimated 600,000 Medicare recipients must change plans
this year because their former Advantage plans will no longer exist,
according to data from Allsup, a provider of Social Security and
Medicare consultation services based in Belleville, Ill.
If you�re new to Medicare this year you can find advice for first-time
enrollees in an article I wrote recently for this newspaper: �Nearly 65?
Time for the Medicare Maze.�
If you are already enrolled in Medicare, you�ll be receiving your copy
of the 2010 �Medicare and You� handbook any day now. This government
booklet will explain changes in this year�s enrollment period and
provide information on different Medicare alternatives. Start your
research by taking a close look at that publication, but do consider the
following, too:
IS STANDING PAT AN OPTION? Determine if your existing plan is still
available � and still right for you.
If you are a member of one of the private Medicare Advantage plans that
has been eliminated, you should have received a notice from your insurer
by now. If you have any doubts, call your insurer.
If you do nothing and your plan is eliminated, you will automatically be
enrolled in traditional, government-provided Medicare A and B plans. But
you will not be enrolled in a prescription drug plan and will have to do
that separately through a private insurer during the Nov. 15-Dec. 31
enrollment period.
But even if your current plan will continue, you may also be ready to
make a switch. If you�ve experienced any changes in your health or
financial situation in the past year, it�s a good idea to sit down and
take a close look at your existing plan. You may find your Medicare
choice has out-of-pocket costs you can no longer afford.
Traditional Medicare can get expensive, with the monthly premiums, as
well as a $1,000 deductible for hospitalizations and 20 percent
co-payments for most doctor visits. With some Medicare Advantage plans
you can lower those costs, says Paul Gada, Allsup�s personal financial
planning director. (Some people also choose to buy a Medigap or
supplemental policy to fill in what traditional Medicare doesn�t cover.
See the recent Times article �Choosing a Policy to Cover What Medicare
Doesn�t.�
On the other hand, if you�ve become sick, you may find you need more
reliable and flexible coverage than your current plan provides. Most
Medicare Advantage plans work on an H.M.O. or P.P.O. network system, so
going to a doctor out of network can be difficult or more expensive. But
almost all health care providers take plain old Medicare, says Judith
Stein, founder of the Center for Medicare Advocacy, a nonprofit patients
advisory group. That makes �traditional Medicare the most flexible
option out there,� Ms. Stein said.
PICKING A NEW PLAN You�ll need to compare your options. That usually
entails weighing prices and coverage for the Medicare Advantage plans
offered in your area � to one another and to traditional Medicare.
In most cases, you�ll want to compare competing Medicare D drug plans as
well. With these, you�ll want to look at price as well as which drugs
are covered. Always make sure that the drugs you use will be covered by
the plan you choose. Medicare D plans change the list of covered drugs
from year to year, so it pays to call the insurer directly to check.
By now you�ve probably gotten an onslaught of mail from insurers that
offer Medicare Advantage and Medicare D plans in your area.
�Companies are allowed to start marketing for the annual enrollment
period on Oct. 1,� says Seemin Pasha, director of policy and
communication at Health Assistance Partnership, a privately financed
project of the Families USA consumer advocacy group. �But sifting
through all these materials can be confusing.�
For help, log onto Medicare .gov. Along with lots of clear information,
the site offers tools that will help you find private insurer plans in
your area and help you compare prices and coverage.
You can also call or visit your State Health Insurance Assistance
Program, known as SHIP, which is run by the government. Counselors
provide information and help you compare plans without charge. To find
the SHIP office in your state, go to www.hapnetwork.org/ship-locator.
That office will refer you to the location in your county. Or call your
local agency on aging and ask for a SHIP location near you.
For-profit companies like Allsup, for a fee, will help clients navigate
the system and enroll in the plan of their choice. At Allsup, a range of
services is available for about $200.
DON�T DELAY Try to sign up for your new coverage by early December,
especially if you are choosing a plan with a private insurer.
Because the annual enrollment period ends Dec. 31 and coverage starts
Jan. 1, late enrollees could experience some snags in the paperwork.
Sign up early and you�re more likely to get on the books and get your
insurance cards well before the new year starts.
Keep in mind if you do make a mistake or change your mind, the
government allows some limited changes during what it calls open
enrollment, from Jan. 1 through March 31. During this period you can
switch from one Advantage plan to another or switch from an Advantage
plan to traditional Medicare and vice versa.
What you can�t do, however, is join or switch a Medicare D plan, unless
you already have a plan with prescription drug coverage, according to
Medicare.gov. You also may not drop Medicare D coverage during this time.
Lois
which would be cheaper but I won't take a chance of the plan dropping any of
my doctors or the hospital that I've gone to several times. I have been
going to the same primary care doctor and the same gynecologist for more
than 15 years and the same opthamologist for 30 years. They are all younger
than me so I hope they won't retire before I die.
Lois
"Jim_Higgins" <gordi...@hotmail.com> wrote in message
news:hcg3vb$4en$1...@news.eternal-september.org...
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Jim_Higgins
I posted this for info as this doesn't affect me since I have Medicare
as primary payer and Tricare for Life as secondary payer.
AndyS
> Keep in mind if you do make a mistake or change your mind, the
> government allows some limited changes during what it calls open
> enrollment, from Jan. 1 through March 31. During this period you can
> switch from one Advantage plan to another or switch from an Advantage
> plan to traditional Medicare and vice versa.
Andy comments:
I have a Medicare supplement policy with one insurer and would
like to switch to a cheaper plan with a different insurer..
It isn't allowed except under certain conditions, such as my
present insurer stops providing the plan in my area, or, I have
damn near NOTHING wrong with me, --- even high blood pressure
or diabetes or a big slew of other stuff that is classified as a
"pre-existing condition", even tho my coverage has been
continuous for 50 years. There is no automatic acceptance.
This is unlike non-Medicare plans, where just having continuous
coverage usually makes acceptance automatic...
So, I would council folks to shop carefully the first time, since
they
may not be able to switch from one supplement insurer to another.
HOWEVER, locally Humana offers an Advantage plan that doesn't seem
to have these restrictions. So I can change to an Advantage plan, but
I
can't change back unless I'm in perfect health.....This makes me
reluctant
to switch just to save a thousand a year or so.... I don't like to
do
stuff that can't be undone if I can avoid it.
Shop carefully.
Andy in Eureka, Texas