Is your current Medicare coverage still appropriate?

Open enrollment is an opportunity to change plans.

By Rob Howard
Associate Editor

Medicare ‘Open Enrollment’ started October 15, and continues through December 7. All people with Medicare can change their Medicare health plan and prescription drug coverage each year during open enrollment. Medicare recommends that you evaluate each year whether a different Medicare plan would be better for you. Few people do this because it is a complicated task.

Good questions to ask yourself when reviewing your coverage include:  Could I do better? Am I over-insured? Can I do better on my drug coverage? Would it make financial sense to change from a Supplement plan to Medicare Advantage? Would a different drug plan be better for me?

How do I figure it all out?

Step 1. Figure out how often you had medical care this year and last year, and what you spent on that care. You can find that information at www.MyMedicare.gov, or if you have a supplement plan or Advantage plan, at your insurance company’s website. Similarly, how many drugs do you take, and what are they costing you? This information is usually available from your Part D insurance company, your Advantage plan provider, and possibly through your pharmacy or on their website. And, if your drugs are brand-named, there may be cheaper generics available. You might want to talk with your doctor about that, even if you decide to keep the plan you have.

Step 2. Are there other alternatives available to you for medical care and prescriptions drugs. Did you and your partner recently get married? If he still works, you may be eligible for coverage under his employer health plan. Are you a veteran? You may be eligible for medical care from the VA: you can apply online at www.va.gov and in general, you will get a rapid response by mail. You can also apply by phone, by mail, or in person at any VA medical center or clinic. Call at 1-877-222-8387 for information about any of these options. Is your income very low? You may also be eligible for Medicaid. Eligibility varies from state to state, so call your state SHIP for help. You can get the number for your state at 1-800-MEDICARE.

Step 3. Go to www.Medicare.gov, enter your prescriptions (if you haven’t already), and select your preferred pharmacies. On the next page you go to, headed ‘Refine Your Plan Results,’ you can limit the plans displayed by such things as your monthly premium, your drug deductible, your drug options (for example, you might want to display only plans that cover all the drugs you are taking), and several other options. When I am doing this, I generally ask to show only plans that have all my drugs. The website will display all the plans that meet your criteria, initially displayed from lowest estimated annual health and drug cost, to highest.

Step 4. If you are happy with the coverage you have, you don’t need to do anything. The plans you have selected will continue (unless they have notified you that they are not going to offer the plan in your state for the next year).

If you see a plan, or several plans, that interest you, you probably want to do a little more research, which you can do from Medicare.gov. Here are some of the details you should explore.

• Does the plan allow you to see your current doctors and go to your favorite hospital? The plan website usually has a provider directory where you can find this information.
• What kind of co-pays does the plan require? Medicare Advantage plans usually require copay for each doctor visit, for the first four or five days of hospitalization, and for other services.
• What other things does the plan provide? For instance, some plans offer dental, hearing and vision coverage. Many plans offer plans like ‘Silver Sneakers’ which gives you a free fitness center membership. This is an important benefit, since an active senior is probably a healthier senior, and gym memberships often cost as much as $500 a year.

When you have selected coverage that you like, you can enroll from the Medicare.gov website, or by calling 1-800-MEDICARE.

If you can’t afford these plans, contact your state’s SHIP for help in finding affordable options.

You have until December 7.

The Gayly – November 3, 2015 @ 1:25 p.m.