Time to comparison shop for Medicare coverage

Herald Health CorrespondentOctober 8, 2013 

20130430 Rising costs

300 dpi Jeff Goertzen illustration of people being pulled aloft by balloons labeled with a caduceus; can be used with stories about rising health care costs. (Orange County Register/MCT)

GOERTZEN — MCT

Annual open enrollment for Medicare drug plans and Medicare Advantage plans begins Oct. 15 and making the right choice could save you a lot of money in 2014.

While it may be tempting to simply do nothing and let your current plan roll over, there are many reasons to take a closer look.

Plans vary on what medications they cover and how much you'll have to spend for premiums and co-pays. Even the same prescription plan is likely to make changes every year, meaning it may be no longer be the best one for you.

For people eligible for Medicare in Manatee County, there are more than 25 prescription plans and more than 20 Medicare Advantage plans to choose from for 2014.

Digging into the details of all of them may seem a little overwhelming, however, the Medicare Plan Finder at www.medicare.gov/find-a-plan makes it easier to compare plans and prices. You provide your zip code, medications and pharmacy and the plan finder sorts through the list for you to make comparisons based on your preferences.

If you don't like to use a computer or would like additional help, volunteers from Serving Health Insurance Needs of Elders, know as SHINE, can assist you through in-person appointments or by telephone.

Here is some useful background for making choices:

Enrollment

• The enrollment period is from Oct. 15 to Dec. 7. Coverage for the plan you choose begins Jan. 1, 2014. If you don't do anything, the plan you had for 2013 will be automatically renewed.

• In most cases, you can't change plans except during open enrollment. That means the plan you choose will be in effect throughout 2014.

Original Medicare vs. Medicare Advantage

• You can choose either original Medicare that covers medications through additional prescription plans from private insurers, or a Medicare Advantage plan that covers both healthcare and medications.

• There is a standard premium for original Medicare; the prescription plans also have premiums but they differ in cost and so do their co-pays and covered medications.

• Medicare Advantage plans are from private insurers. They will be listed as Medicare Health Plans on the Medicare Plan Finder. Many don't charge premiums and may offer rebates for what customers would be paying for original Medicare premiums. The plans also may offer perks like free fitness-club membership and vision care.

The rebates and extras can be enticing. You could save money, especially if you're healthy and don't need much healthcare. But it's important to look at the details of what you'll have to pay if you ever needed hospital care or high-cost treatments.

• In Medicare Advantage plans, the network of doctors may be limited; insurance companies negotiate fees and services with healthcare providers and not all join.

If you want to go to your current doctor or specialist, check to see if they are in the plan.

The insurance company will have a list and you also can call your doctor.

Gap coverage

• The "gap," also called the "donut hole," is a limit on coverage once a certain amount has been spent on medication.

• Some prescription plans and Medicare Advantage plans offer extended gap coverage that varies in amounts and accepted medications.

What's new for 2014

Compared to last year, the deductible for the stand-alone drug plans has gone down slightly, from $325 in 2013 to $310 in 2014. But premiums and amounts for co-pays seem to be higher overall, said Gudrun Bennett, a volunteer for SHINE in Bradenton.

"One of the things that is even more important than it used to be is to check out what the co-pay will be at every pharmacy. For instance, in the Humana-Wal-Mart plan, the cost of prescriptions will be lower at Wal-Mart than if you went to other pharmacies," said Bennett.

For Medicare Advantage plans, many co-pays have changed, especially for high-cost care such as in-patient hospitalization where patients will be required to pay a bigger percentage of the cost, she said.

Looking at the details and comparing plans will show what's right for you.

Susan Hemmingway, Herald health correspondent, can be reached at shemmingway@hotmail.com.

For information and help:

• Go to the Medicare Plan Finder at www.medicare.gov/find-a-plan for a look at available prescription plans and Medicare Advantage plans for 2014. The Plan Finder can show customized comparisons.

• To get in touch with a SHINE volunteer, call 800-963-5337. Volunteers are trained through the Area Agency on Aging and assist people during open enrollment or for other Medicare-related issues throughout the year. Volunteers can assist in-person by appointment or by phone.

• Or go to enrollment sessions being held by SHINE where volunteers can help you compare plans. Appointments are necessary; call 800-963-5337. Dates and locations: 9 a.m.-1 p.m. Oct. 28 at

Parrish Community Center, 12214 U.S. 301 N., Parrish, and Nov. 18 at Renaissance on 9th, 1816 Ninth St. W., Bradenton.

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