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Finding the Best Medicare Plan for You during Open Enrollment

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This year’s Medicare Annual Open Enrollment period begins on October 15th and runs through December 7th. During this time Medicare beneficiaries can make changes to their health and prescription plan coverage for the upcoming year. Plan changes will take effect on January 1, 2016.

It’s a bit complicated to change your health insurance plan, so few beneficiaries take advantage of this opportunity. They do nothing – and automatically renew their current plans. But insurance plans change each year, and your needs may have changed as well. Making the effort to shop around can save a Medicare beneficiary hundreds or even thousands of dollars next year.

Unfortunately, the Open Enrollment period is also a time of opportunity for con artists who prey on Medicare beneficiaries. Seniors must be careful to protect themselves from identity thieves who are seeking personal and financial information. Click here for some ideas on how to avoid common scams and identify theft.

Original Medicare

Most Medicare beneficiaries have coverage through Original Medicare. Original Medicare is coverage managed by the federal government. In most cases this allows you to go to any doctor, other health care provider, hospital, or other facility that’s enrolled in Medicare and accepting Medicare patients. But most drug prescriptions are not covered by Original Medicare – to get drug coverage you will need to obtain a prescription drug (Part D) plan. Since recipients generally have to pay a portion of the cost for each service covered by Original Medicare you will also want to consider obtaining Medicare Supplement (“Medigap”) insurance.

Medicare Advantage Plans

As an alternative to Original Medicare, beneficiaries can choose to enroll in a federally subsidized private Medicare Advantage (MA) plan. These managed care plans are offered by private insurance companies that Medicare approves. MA plans typically place some limitations on the beneficiary’s access to health care providers but they may also expand coverage to some services not covered by Original Medicare. Many MA plans offer coverage for prescription drugs.

During the open enrollment period beneficiaries can enroll in an MA plan, change to a different MA plan, or move to original Medicare from a MA plan. (If you are considering moving to or from traditional Medicare, see my earlier article Why I chose Original Medicare over a Medicare Advantage Plan). About 30 percent of Medicare recipients have chosen to enroll in an MA plan rather than Original Medicare.

Part D Prescription Drug Plans

During open enrollment, Medicare beneficiaries can also enroll in a Part D drug plan for the first time or change to a different drug plan. For some guidance on choosing a drug plan see my earlier article Tips on Choosing a Medicare Prescription Drug Plan.

Use the Medicare Plan Finder

A good way to find and compare your options for Medicare Part D and Medicare Advantage plan coverage is to visit the Medicare plan finder online. Click here to access this tool. Plan information for the upcoming year 2016 is now available on the Medicare plan finder.

Once on the plan finder website you can find and compare the plans that are available in your region. Plug in your basic information including the prescription drugs you expect to be taking in 2016. The plan finder will then provide you with a list of stand-alone Part D drug plans (for those with Original Medicare) and Medicare Advantage plans that are available to you. The list will include the monthly premium, your estimated total annual drug costs and other valuable information.

The Medicare plan finder is a marvelous tool. If you are comfortable using the internet, you will likely have your list of plan options in less than 30 minutes. Those who are less comfortable on the computer can contact 1-800-Medicare, or their State Health Insurance Assistance Program (SHIP), for assistance in comparing plans.

My two-cents: Instead of making a choice based on the insurance company Medicare plan solicitations that have been arriving in your mailbox, rely on Medicare itself (e.g. the plan finder) or your state SHIP to find the plan that best meets your needs. In Pennsylvania, the state SHIP is called “Apprise” and can be contacted at 1-800-783-7067.

Open Enrollment Period Do’s and Don’ts

A few years ago, the Pennsylvania Department of Aging issued a list of “Do’s” and Don’ts for Medicare beneficiaries to follow during the Medicare open enrollment period. Here is my revision and update of the Department’s advice:

Medicare Enrollment “Don’ts”

  • Don’t take a call from someone you don’t know or trust offering to help you navigate Medicare plans. You should be the one initiating any queries.
  • Don’t give out any personal information, such as your Medicare number, to unsolicited callers. Remember: your Medicare number is the same as your Social Security number.
  • Don’t toss the mail you received from your health insurer and competing firms about your 2016 Medicare plan. You need to read this material to find out what’s in store for you and learn about potential alternatives. [Check out any plan you are considering using the Medicare Plan Finder]
  • Don’t assume that you (or your spouse) have the most appropriate Medicare plan. Some married couples shouldn’t be on the same Medicare plan. Depending on the medications each of you take and the doctors you both need to visit, one Medicare plan may be better for one spouse than another.

Medicare Open Enrollment “Do’s”

  • Do review your current carrier’s Medicare plan for 2016 to ensure you understand any pending changes. Call your insurer with any questions. Then start researching alternatives you can find at www.Medicare.gov 
  • Do study any changes in your plan’s drug coverage and cost. (This will be your Part D plan if you have Original Medicare). Check to see whether each medication you take now or may need next year will be affected. Then, compare this with other plans you could buy.
  • Do seek expert help if you need it. Start with your State Health Insurance Program (APPRISE, if you live in Pennsylvania) which provides free, unbiased, one-on-one counseling and assistance to people with Medicare and their families. [If you don’t live in Pennsylvania, you can find contact information for your state’s Health Insurance Program here].
  • Do take your time, but be sure to make your choices before open enrollment ends on December 7. Although you shouldn’t procrastinate, you should take time to explore your healthcare choices. Medicare’s website, www.Medicare.gov and the Medicare Plan Finder can help you. Even if you wait until the last day of open enrollment, you can still change your Medicare plans for coverage beginning January 1.

For those new to Medicare who need basic information www.Medicare.gov is the site to consult for explanations of Medicare, whether it is Original Medicare (Part A, Part B, Part D, and Medigap/Supplemental Plans) or Medicare Advantage Plans. For Pennsylvania Medicare recipients, state trained APPRISE counselors can provide free unbiased counseling. Find out more by calling APPRISE at 1-800-783-7067.

[Original Source: Pennsylvania Department of Aging “Friday Wrapup,” November 1, 2013.]

Further Reading

Tips on Choosing a Medicare Prescription Drug Plan

Medicare Plan Finder

Medicare and You (2016)

Stop Medicaid Fraud (information from U.S. Department of Health and Human Services and the U.S. Justice Department)