Thursday, 10 October 2013
Medicare Open Enrollment: What You Should Know
The annual Medicare Open Enrollment period begins next week on Tuesday 15 October and continues through Saturday 7 December. Among the things you can do during this period are
- Change from Original Medicare to a Medicare Advantage Plan
- Switch from one Medicare Advantage Plan to another Medicare Advantage Plan
- Join a Medicare prescription drug plan (Part D)
- Switch from one Medicare drug plan to another Medicare drug plan
- Drop your Medicare prescription drug coverage completely
First Things First
Even if you are happy with the Medicare coverage you have, this enrollment period is, nevertheless, a good reminder to review that assumption just in case there are changes you would like to make.
• If you are satisfied with the plan(s) you currently have, you don't need to do anything. Just keep paying your premiums as they come due.
• The exchanges (also called marketplaces) for Obamacare (the Affordable Care Act or ACA) have nothing to do with Medicare. Period. In fact, if you have Medicare in any of its forms, it is illegal for anyone to sell you a marketplace/exchange health policy.
• In addition, you are not allowed to choose an Obamacare plan instead of Medicare. There are one or two minor exceptions to that prohibition which you can read about in Medicare and the Health Insurance Marketplace [pdf] from cms.gov.
What Today's Blog Post Will Tell You
I was astonished to find that last year at this time I wrote an entire week of blog posts about Medicare and the annual enrollment period. Good god, where did I find the time, energy and focus.
You won't get anything that thorough this year but Medicare is a complex program and last year's entries are amazingly detailed while still being useful. So if you are doing anything more difficult this year than checking to see if there is a more affordable drug or Advantage plan, I suggest you read last year's posts. The five-part series begins here.
Today's post will give you an explanation of how to navigate and compare 2014 Part D and Advantage plans as the enrollment process applies to the majority of people already enrolled in Medicare.
IMPORTANT: Thanks to the Congress people who have forced our current government shutdown, this notice appears at the top of the main pages at cms.gov as well as medicare.gov:
Due to the government shutdown, information on this website may not be up to date.
That means enough Centers for Medicare and Medicaid (CMS) employees have been furloughed that you cannot trust the premiums, deductibles, copays or other information in the plans. Plus, as of yesterday, Wednesday, none of the drug plans have star ratings listed yet.
Star ratings are useful because they indicate quality of each plan ranked in four categories: customer service, complaints, member ratings, and accuracy of information.
The shutdown undoubtedly means, too, that telephone customer service at Medicare is limited.Types of Medicare
There are four “parts” to Medicare. If you are already a Medicare enrollee, you probably know this, but here's a rough overview anyway:
• Part A: “Hospital Insurance” helps cover inpatient care in a hospital or skilled nursing facility, some home health care or hospice care. This is free.
• Part B: “Medical Insurance” helps cover physician visits and medical services or supplies that are not covered by hospital insurance. This is optional and if you choose to have it, premiums are usually deducted from your Social Security payment.
• Part C: “Medicare Advantage” plans are available in many areas and are used by patients to receive all their health care services through one provider organization. This replaces Parts A and B coverage although you must continue to pay the Part B premium. Some Advantage plans pay or part of that premium.
• Part D: “Prescription Drug Coverage” helps cover medications prescribed by a doctor.
Parts A and B are what is known as Original Medicare. Some people with this coverage buy “Supplemental” plans that help pay for what Parts A and B do not cover.
You will find detailed explanations of those in last year's posts.
What To Do Before December 7
If you are enrolled in an Advantage plan, you have probably received a booklet explaining changes for next year. If you are considering moving to a different Advantage plan for 2014, those choices will turn up on the Medicare.gov pages I explain below.
The majority of Medicare beneficiaries are enrolled in Original Medicare and most of those also have a prescription drug plan. If that's you, by now you should have received these items via postal mail:
- The Medicare and You 2014 handbook. (Online version [pdf] is here)
- A booklet from your prescription drug provider that explains the plan's updates and changes for 2014
Using myself as an example, the drug plan I currently have has doubled the premium for 2014, lowered copays for two tiers of drugs by 20 and 22 percent and retained the same copays for the other three tiers.
Because I take no prescription drugs and there is no way to guess what might become necessary in the future, I am again purchasing the least expensive plan which is $30 cheaper for 2014 than last year's coverage, with a deductible that matches that of my current provider.
Mine is so simple that having made that choice, I would now be done with this annual chore except that due to the government shutdown I will need to confirm dollar figures before I purchase new coverage.
Of course, the process will be more complicated for people who take prescription drugs but the medicare.gov website, over the past few years, has made comparison shopping a relatively easy process.
In fact, the hardest part is trying to figure out how to get started, so I will explain.
Start at medicare.gov. There is no obvious indication of what to click, for example - “open enrollment,” “2014 drug plans” or “2014 Advantage plans” as would make sense.
• It is therefore necessary to click the wide, yellow “pill” on the left near the top with the words, “Find health and drug plans” or just below that on the right, click the blue words, “Review your health and prescription drug coverage options.” Both take you to the same page.
• On that page, you have two choices: You can use the short one, Enter Your Zip Code, or the longer one below that asks for more information. I tried both and got the same result each time. It might change if you have a drug list that you have saved at this website in the past.
• There follow four or five questions about the kind of Medicare you have and another page where you can list all the prescription drugs you use. If like me, there are none, click “I don't take any drugs.”
• Next, choose the kind of coverage you want – “Medicare Health Plans” (you wouldn't know it but this means Advantage plans) or “Prescription Drug Plans (with Original Medicare)” - whichever applies to you.
• The next page will be the list of the plans available in your Zip Code which you can sort a half dozen different ways from a dropdown menu. Read through the plans making check marks next to the ones you want to compare side by side.
Although enrollment does not begin until next Tuesday, the website is open now and you can get started on your choices.
Where To Get Help
If you are new to Medicare and enrolling for the first time, I suggest again that you visit my posts from last year. There is a lot of good information there to help you understand many of the ins and outs.
Further, if your Medicare circumstance is particularly complicated, you might be able to find help at your local senior center. Many provide experts at this time of year for no cost usually by appointment.
Also State Healthcare Insurance Assistance Programs (SHIP) offer free counseling by telephone and face-to-face. You can find your local SHIP branch at this webpage.
Government Shutdown and Medicare Enrollment
And don't forget to wait until the government shutdown is ended to check the dollar figures and other particulars again before committing to a new drug or Advantage plan.
In fact, give Medicare several days or a week after the government reopens to bring the website up to date.
If the government shutdown becomes lengthy, to be fair to everyone, Medicare should extend the open enrollment period. In such a circumstance, I'll be asking you all to inundate your Congress members with that request.
At The Elder Storytelling Place today, Arlene Corwin: Wait It Out