Understanding healthcare coverage can be overwhelming.
And keeping up with changes in Medicare benefits is no different. For many people, that translates into doing nothing about updating their current coverage.
-A majority (55 percent) of Medicare beneficiaries believe their health benefits will stay the same in 2010, according to The "Medicare Beneficiary Insights" poll by Suffolk University and Silverlink Communications.
-The poll also showed that 85 percent of Medicare beneficiaries are not currently planning to switch plans this year, and the majority will spend only minimal time (two hours or less) researching health plan options.
But experts say it isn't wise to blindly re-enroll in existing Medicare plans. Medicare and its private sector plans typically make annual changes to:
-Medical benefits
-Prescription benefits
-Coverage limits
-Consumer premiums
-Out-of-pocket expenses
So current users and new enrollees need to take the time to review plan options in order to get the best coverage possible.
-Make sure you know current enrollment dates.
-For 2009, the window is November 15 through December 31. Those eligible for Medicare can review and - if necessary - adjust their Medicare coverage, which consists of traditional Medicare or private sector plan options licensed to operate in Medicare; Medicare Advantage and Medicare Part D.
-If you do not choose new coverage, you will be automatically re-enrolled in the same coverage you had.
To help you evaluate your options, Chris Hakim, the Director of eHealthMedicare.com, encourages people to answer these questions.
Does my coverage match my changing healthcare needs?
"If you're managing a chronic condition, like diabetes, heart disease or cancer," says Hakim, "make sure your coverage keeps pace with your needs for new or existing medications. You also want to be sure you can continue to see your primary care physician or specialist." Hakim also recommends that if you're having elective surgery in the coming year, make sure it's covered in your existing plan or your coverage.
In many cases spouses have the same plan. But, if your health care needs changed this year, or if your spouse's needs changed, be sure to review your coverage. "If you're used to getting insurance from an employer, then you're likely to think of your health insurance as a family policy where you're all on one plan. But, Medicare allows you and your spouse to have different plans that are 'right-sized' for each of your individual needs," says Hakim. Choosing the right plan for your individual needs can help you save money.
Will I have my same doctor?
Check with your primary care physician, specialists and your private plan to make sure you can continue to see your doctors. Medicare's contracted networks of doctors and hospitals are subject to change, so find out if your doctor will be in the plan. "If you elect traditional Medicare, which allows you to see any doctor or visit any hospital that accepts Medicare," says Hakim, "it's still a good idea to confirm your doctors are participating in Medicare."
Will my premiums and deductibles increase?
Traditional Medicare (Parts A & B), private sector plans in the Medicare Advantage program (Part C), and the Prescription Drug (Part D) program are likely to have changes in 2010. They may result in either savings or additional cost to consumers based on the coverage you select. Make sure you understand how these changes impact you.
Get the Right Prescription Drug Coverage
Medicare Part D provides coverage for name-brand and generic prescriptions. Review your current medications with your doctor and ask about potential medication changes for next year. Then, review Part D coverage to make sure it covers what you need.
"eHealthMedicare.com has a 'Doughnut Hole' Calculator, powered by Destination Rx, to help calculate the money you could be required to pay out of your own pocket for prescription drugs," says Hakim. "Medicare Part D typically covers an initial portion of your prescription drug costs, up to a pre-set limit. Once the limit is reached, you'll pay out of pocket until you reach the 'catastrophic coverage threshold.' Once the threshold is reached, Part D coverage kicks back in to cover the remaining costs.
"It's important to confirm the coverage you have and to research other name brand or generic-equivalent medications that may be less expensive. The 'Doughnut Hole' Calculator is an easy-to-use tool to help you maximize your Part D benefit."
Get Knowledgeable Advice
There are many resources available to you, including these:
-Medicare: www.medicare.gov; 800-MEDICARE
-The National Council on Aging: www.ncoa.org
-The Medicare Rights Center: www.medicarerights.org
-eHealth: www.eHealthMedicare.com
You can also check out the State Health Insurance Plans (SHIPs), which are part of a federal network of State Health Insurance Assistance Programs located in every state.
Hakim also encourages people to try www.eHealthMedicare.com, a Web site with information about traditional Medicare and private Medicare options.
"At eHealthMedicare.com we're offering comprehensive Medicare information, in easy-to-navigate Web pages and straightforward language," says Hakim. "We also provide access to quality Medicare carriers and phone support with trained professionals."
The difference between picking a plan that's right for you and one that isn't could be thousands of dollars per year. Take the time now to study your choices so you can get the coverage you need next year.
Changing Medicare Plans?
If you're changing Medicare plans, the Medicare Rights Center recommends enrolling in the new plan without disenrolling from your old one. Enroll by calling 800-MEDICARE - you will be automatically disenrolled from your previous Medicare private plan with your new coverage starts. Find out more at www.medicarerights.org.
Enrolling for Medicare
Most people who are 65 and older, some younger people with disabilities can get Medicare. If you aren't sure if you can get Medicare, call the Social Security Administration toll-free at 800-772-1213. You'll need to provide your Social Security number and date of birth when you call.
Maximizing Your Prescription Drug Coverage
Use a "Doughnut Hole" Calculator to confirm the prescription drug coverage you have under Medicare Part D. Research other name brand or generic-equivalent medications that may be less expensive with the calculator at eHealthMedicare.com.
And keeping up with changes in Medicare benefits is no different. For many people, that translates into doing nothing about updating their current coverage.
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