Medicare open enrollment -- the period when people with Medicare can make unrestricted changes to their coverage -- will run from October 15 to December 7 this year.
It’s a sensible change.
Medicare is an annual topic of conversation at Thanksgiving gatherings, as adult children help their parents decipher increasingly complex choices. Previously, open enrollment ran from mid-November until December 31 -- a frenetic time of year for most families. The new dates allow time to gather information about current coverage and research the new options online well advance of stuffing the turkey and mashing the potatoes -- and to change coverage before becoming engulfed in holiday shopping and festivities.
For readers new to this daunting task, a quick review of Medicare basics:
Part A is hospital and inpatient coverage.
Part B covers doctors and outpatient services.
Part D covers prescription drugs.
Part C is universally known as Medicare Advantage, which combines A, B, and D coverage in a single plan administered by insurance company. Medicare Advantage typically restricts you to the insurer’s network of doctors and hospitals.
Alternatively, you can opt for Original Medicare, which consists of Parts A and B, is administered by the government, and lets you go to any doctor or hospital that participates in Medicare. (By definition, this includes all the doctors and hospitals who participate in Medicare Advantage networks, although costs vary with each plan.)
If you choose Original Medicare, you must buy a standalone Part D prescription drug plan. You may also decide to buy a supplemental private insurance policy (called Medigap) to cover expenses not picked up by Original Medicare – such as co-pays, deductibles, and vision and dental services. (Medigap policies only work with Original Medicare. You can’t combine them with a Medicare Advantage plan.)
Okay – so what should you pay attention to during open enrollment?
Everyone who has Medicare should review all their coverage options, says the Medicare Rights Center, a consumer-advocacy organization. Even if you like your current plan, it may not be the best option for you in 2012. The reason: Many Medicare Advantage plans change their costs and benefits every year. And Part D prescription drug plans often change their formularies – the lists of the drugs they cover. If you don’t pay attention, you could find that come January 1, 2012, your plan no longer covers one or more of your regular prescriptions.
Your insurer must alert you to upcoming changes in an Annual Notice of Change (ANOC) letter, which you should receive by September 30. But the ANOC letter doesn’t provide any personalized information. “It won’t say, ‘Joe, you take these three drugs, this one isn’t going to be on the formulary anymore, and this one is going to be priced differently,’” says Joe Baker, president of the Medicare Rights Center. “It will just be general information --‘We’re changing the formulary, the pharmacy network, the premium.’” To find out how the changes affect you specifically, you must call the plan for a complete copy of the new formulary, which should also be posted on the plan’s website.
Don’t just look for your drugs. Also check for any new Part D coverage restrictions, such as a prior authorization requirement; a quantity limit, which could increase your cost by forcing you to buy your medicine more frequently; or ‘step therapy’ on certain drugs, which requires you to try another drug before the plan will cover your prescribed drug. Baker says there’s also a growing trend for Part D plans to differentiate between ‘preferred’ and ‘non-preferred’ pharmacies within their network. You pay the least when you use ‘preferred’ pharmacies – so make sure that your own pharmacies are on the preferred list.
If you are considering (or reviewing) a Medicare Advantage plan, make sure you understand how it works. Your check list should include questions like:
- Will I be able to use my doctors or other providers I want to see? Are they in the plan’s network, and are they taking new patients who have this plan?
- Which specialists, hospitals, home health agencies and skilled nursing facilities are in the plan’s network?
- How much will it cost to see my primary care physician? A specialist?
For more questions about Medicare Advantage plans, see this invaluable guide from the Medicare Rights Center. For questions to ask about Part D plans, either as part of a Medicare Advantage plan or as a stand-alone prescription drug plan, see 'How do I compare Medicare Private Drug Plans?'
Use Medicare's Plan Finder tool to select the best plan for your needs -- but don’t enroll until you have called the plan and confirmed the information you’ve gathered with a plan representative. Plan Finder and 800-MEDICARE may not have the most up-to-date information, explains a Medicare Rights Center spokeswoman. Keep a record of your conversation with the plan representative, she adds. Misinformation from a plan representative, if documented properly, in some situations can give someone a Special Enrollment Period to switch plans or go back to Original Medicare.
Once you’ve confirmed the information, Baker recommends that you enroll in the new plan by calling 1-800-MEDICARE rather than the plan itself. This reduces the chance of administrative error, which happens sometimes when a plan sends the enrollment information to Medicare. Take notes of your conversation with the government representative, too.
When dealing with any bureaucracy, it's essential to keep records. People should document all calls (with name of representative, date and time of the call, and the information they were given) regarding health insurance decisions to protect themselves if they were given bad information, says the Medicare Rights Center.
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