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Medicare and Open Enrollment

The Huffington Post The Huffington Post 1/11/2015 Terry Savage

Medicare's open enrollment period is the time of year when you can change your Part D, prescription drug insurance or change from traditional Medicare to Medicare Advantage, or change Medicare Advantage plans. Open enrollment runs from October 15 through December 7th. (Don't confuse that with open enrollment for Obamacare, which started November 1st, and will be the subject of a separate column.) Medicare open enrollment is a complex but important process for seniors and the permanently disabled.

The government website www.Medicare.gov is a great source of help, many community agencies offer advice, and help is available from private websites and insurance brokers like eHealth.com .

Here are five basics you should understand to make the process easier.

1. The Basic Parts of Medicare. If you have earned coverage through years of work, you are automatically covered for Medicare Part A (hospitalization) when you reach age 65. Yes, that's before you reach full retirement age for Social Security.

You become eligible for Medicare Part B (physicians, and other benefits) when you reach full retirement age. But you don't have to sign up for Part B if you are still working and have comparable coverage at work. When you retire, you'll want to immediately be covered by Medicare Part B. But it doesn't cover everything, leaving you with co-payments, coinsurance and deductibles.
That's why you should purchase a Medicare supplement (Medigap) policy which covers things like co-payments and deductibles that are not covered by Medicare. If you sign up for a supplement policy within 6 months of becoming eligible for Medicare Part B, you cannot be turned down from the most comprehensive coverage because of existing health problems.

Prescription drugs are covered separately in traditional Medicare, under Part D. When you enroll in Part B, you must sign up for Part D - prescription drug coverage, or face serious penalties (see below).
2.Medicare Advantage. Sometimes called Medicare Part C, Medicare Advantage is a combination of all the parts of traditional Medicare into one policy. You pay one fee, or premium, for all your coverage. But you must still choose the lowest cost Medicare Advantage plan, based on the cost of any co-payments for drugs, and based on the physicians and hospitals included in the Advantage plan you choose. You can only switch from traditional Medicare to a Medicare Advantage plan during this open enrollment period or change from one Medicare Advantage plan to another. And if you have a Medicare Supplement but want to try Medicare Advantage, you can try it for a year and switch back to a Supplement without penalty if you don't like it.
3.Medicare Supplement Choices. Long ago the government decided to standardize coverage for various levels of Medicare supplement plans in policies ranging from A to N, each offering additional coverage such as additional days of skilled nursing, and coverage for foreign travel. Typically, the premiums for these plans rise each year. Changing plans may require health underwriting. Here's a link to the government's Medicare website showing you how to compare supplement plans.

4.Medicare Part D. These prescription drug benefit plans change every year, in terms of the drugs they cover, the co-payments you will pay for a specific drug, the pharmacies they include, and the basic premium for the policy itself. The best way to compare Part D drug plans is to use the "Drug Plan Finder" at Medicare.gov. Since plans and prices vary by geography, you should input your zip code and the exact prescriptions and dosages to find out which will result in the lowest out-of-pocket costs - even if you currently don't take any drugs!

If you don't sign up for Part D when you first sign up for Part B (and don't have comparable private drug coverage) you could be assessed a penalty of 1 percent per month (a 12 percent per year permanent increase in premiums) for every month you go without coverage. And if you don't sign up for Part D during the current open enrollment period, you can't sign up again until next year - costing you that steep penalty in every future year.
5.Help is Available. The Medicare.gov website is easy to use, and they have a helpline. But some national private companies offer online and telephone help in choosing Supplements, Part D drug, and Advantage plans. For example you can contact www.ehealthmedicare.com or call them toll free at 844-866-9688. Their advisor/agents do not receive compensation based on selling any specific plan, so they work in your interest. The same company also offers a search feature for agents at www.Medicare.com -- a private website, not the government site -- putting you in touch with an agent that is familiar with the plans in your area. The prices are the same as those at the government website.
Healthcare is one of the largest costs for seniors and people with disabilities. Yes, the system is complicated at first, but with help you can work your way through it to find the best policies for your situation. And then next year, during open enrollment, you can use them again if you decide to switch or to see if you can save money. It's a never-ending process. And that's The Savage Truth.

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