What You Don’t Know About Medicare Open Enrollment Can Cost You

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docwithpatientsmallMikol and I wish you well from AgingParents.com.
As you’re probably seeing ads on TV or getting solicitations in the mail about Medicare plans, here are a few things you should know if you, your aging parents or a family member have Medicare or are about to become eligible soon.
There is a lot of competition to get your Medicare dollars and your money for the supplemental plans most people buy. Medicare only pays 80% of covered medical expenses so most people buy a supplemental plan.  Some insurers put both together and offer you an all-in one thing:  basic Medicare, a supplemental component and a prescription drug component together.   
Every insurer out there will try to get you to think their all in one plan is better than someone else’s.
The nonprofit organization, National Council on Aging offers a free educational service for those boomers just getting ready to enroll in Medicare, and for those already receiving it who want to avoid making mistakes. It’s called My Medicare Matters. Open enrollment started October 15. That means if you want to start the benefit or want to change plans, now is the time.
It’s always difficult for an ordinary person who isn’t experienced in comparing insurance plans to figure out what to do. If you already have Medicare, should you change?  If you are just getting started and are being besieged with sales hype about various plans (they’ve got your number!) it can be confusing.  I face this myself now.  Should I get out of the Medicare Advantage plan I have?   
A deciding factor for me came from working with a 66 year old client who has traditional Medicare. She lives in suburban San Francisco and recently left a nursing home, following a very long stay after a stroke.  I was helping her very overwhelmed adult daughter look for a doctor for her outside the nursing home.  Her former doctor retired. The nursing home discharge person, who could have done a far better job, had no doctor recommendations.  I researched the area on the net. Only one out of 8 offices I called would take traditional Medicare and would accept a new patient.  That’s awful!  My client had to make a trip to the ER after she got out of the nursing home and the doctor there gave her a list of suggested doctors she could see for follow up. Not a single one of them would take a new Medicare patient! This is reality.  Doctors don’t necessarily want to accept traditional Medicare. They make less money on Medicare patients than they used to do. 
Insurers have negotiated rates to make it more profitable for the insurer when the patient is in a  Medicare Advantage plan (all in one, Parts A & B as well as D for prescription drugs), and they will switch off covering certain things that are a greater risk to them. When they drop coverage for something you need, you pay out of pocket for it.  Insurers now must offer at least as good coverage in a Medicare Advantage plan as one would get with traditional Medicare. All must also offer certain preventive care services now under the Affordable Care Act, which does help seniors.  Don’t fall for the hype that preventive care is particular or some big deal if you go with any particular insurer. Every Medicare plan is required to offer this benefit of basic preventive care.
I just know seeing the struggle my client had to even get a doctor at all made me want to stick to what I’ve got. I’m a low use kind of person, with no medications to worry about having to cover. Medication coverage is a very important item for most people looking for the best plan. You need to start with that. What do you take and what medications does the plan you have cover?
The NCOA offers tips on how to choose what’s right for you.  They tell us it’s a big mistake to not re-evaluate your coverage every year.  From My Medicare Matters, here are some questions they suggest you ask yourself:
  • Has your health changed in the last year?
  • Is your current plan still meeting all of your health needs?
  • How much have you paid out of pocket in the last year and for what?
  • Is your plan changing in the coming year?  How will that affect your out of pocket costs?
  • Are there better options available to you?
If your doctor is on your plan now, it doesn’t mean the same will be true in the coming year.  If all the medications you take  are now covered now, they may not all be on the approved list your insurer creates for the coming year. They have to inform you about changes, and you need to really pay attention to that.  Research shows that the average consumer could save $300 or more annually if they review their Part D (medication coverage) annually.  In other words, it can pay to switch.
Here at AgingParents.com  I meet adult children who are worried about having to step in and provide financial support for parents whose limited or fixed income does not allow for big changes in out of pocket medical expenses.  If you’re in that category, it will be worth your while to take a good look at your aging parent’s Medicare coverage, now that it’s open enrollment  time once again.  Failure to do so could come back to bite you. If their plan has dropped coverage for an expensive drug they need, will they ask you to pay for it?  Take the time and help out.  Use the resources available such as My Medicare Matters or other benefits counseling services in your loved ones’ community. Free advice is generally available to help you.
Until next time,

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