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Why you must look at your Medicare Advantage Plan Today
Updated:
May 12, 2010
You may also
want to read:
Medicare Advantage open season and
I'm Falling into the Doughnut Hole
Surviving the Medicare Advantage Decision
Robert Fassbach, editor,
www.seniorark.com
When January 1 arrives, your worries about
Medicare Advantage are not over. Not yet. What you do right now
can determine how well you do for the rest of the year
in getting the medical care and prescriptions you need.
If you still have concerns about whether you are
in the right Medicare Advantage Plan (20% of Seniors
choose this method of receiving Medicare), you have
until March 31 to make additional changes.
I turned 65 the day before Christmas 2007,
Selecting a Medicare Advantage Plan that also covered my prescriptions, was a
traumatic experience. I have been studying and
writing about the nuances of Medicare for over
four years
on SeniorArk, and in various other publications. But
until I entered the scene myself, I had no idea of the
extreme confusion surrounding the process. Even now,
having made an "informed" decision for 2010, I am not
completely sure I have made the best choice for my
needs. I have a plan that will work, and it includes
Prescription Drug coverage, but Pennsylvania
has some 100+ plan possibilities out there, all being
offered by private insurance companies interested more
in my money than my health. During insurance company
plan presentations I heard misrepresentation,
half-truths, and outright misinformation. But a choice
was needed, so one was made.
Years ago, when I managed a real estate office in
suburban Washington D.C., my boss, Bill Ellis, told me,
"I just sold my Bethesda home after several years, and
have moved to another one in Potomac. I had no idea what
our buyers and sellers go through every time they move.
I think every manager in our company ought to be
required to move every 5 years just to keep the memory
fresh." He was right. And I found that out
when I turned 65. Now I get it. What we are put through
as we decide on Medicare and Part "D" is a serious
trauma. We are subjected to a real "twilight zone".
So then, if our decisions on Part "D" or
Medicare Advantage were made between
November 15 and December 31, what is there to do between
January 1 and March 31? Well, here goes.
(1) Here is exactly what Medicare says we can do
between January 1 and March 31:
"Between January 1 through March 31 of each year.
Your coverage will begin the first day of the month
after the plan gets your enrollment form. During this
period, you can't do the following:
-
Join
or switch to a plan with prescription drug coverage
unless you already have Medicare prescription drug
coverage (Part D).
-
Drop a
plan with prescription drug coverage.
-
Join,
switch, or drop a Medicare Medical Savings Account
Plan."
Here are the different coverage scenarios permitted
during Medicare Advantage open enrollment:
-
If a person on Medicare currently has coverage in a
Medicare Advantage Plan with prescription drug
coverage, they can use open enrollment to select a
different Medicare Advantage Plan with prescription
drug coverage, Original Medicare and a stand-alone
prescription drug plan, or a Medicare Advantage
Private-Fee-For-Service Plan and a stand-alone
prescription drug plan.
-
If a person on Medicare currently has coverage in a
Medicare Advantage Plan with no prescription drug
coverage, they can use open enrollment to select a
Medicare Advantage Plan or Original Medicare without
prescription drug coverage.
-
If a person on Medicare currently has coverage in
Original Medicare with a stand-alone prescription drug
plan, they can use open enrollment to select a
Medicare Advantage Plan with prescription drug
coverage or a Medicare Advantage
Private-Fee-For-Service Plan with the same stand-alone
prescription drug plan.
-
If a person on Medicare currently has coverage in
Original Medicare without a stand-alone prescription
drug plan, they can use open enrollment to select a
Medicare Advantage Plan without prescription drug
coverage.
(2) Now let's assume that you review
the details of your Medicare Advantage plan and decide that you
are
in the right Medicare Advantage plan with prescription
drug coverage. Or you are in traditional Medicare with a
stand-alone part D drug plan. Then today you need to think about the
doughnut hole. The best time to begin avoiding it is
right now. This week I met with my doctor to go over the
salad of drugs that seem necessary to keep me going each
month. I told him I wanted to find a generic for every
one of them. He was willing to do that with one
exception, and I may still decide to change that one. It
is a statin, and I'm not convinced that Lipitor is
necessarily better than several others out there. I will
need to do a little research on that.
Here
are some examples of the savings when switching from
Brand to Generic:
-
Celebrex 200mg, a medication used for
arthritis, costs about $100 for a one-month supply.
Replace with Meloxican 15 mg (generic for Mobic)
costs about $8. Cost difference,$1100/yr.
-
Lipitor 20mg, used for cholesterol, costs about
$111 for a month's supply. Simvastatin,
(generic for Zocor) cost $11. Savings, $1200/yr.
-
Prevacid 30mg, a medication for heartburn,
costs about $144 for a one-month supply. Omeprazole
20mg (generic for Prilosec) costs about $27, or a
savings of $1400/yr.
-
Tricor 145mg, a medication for triglicerides,
costs around $100/mo. Fenofibrate (generic for
Tricor) costs $37, for a savings of about $750/yr.
Remember for 2010, in the "stand-alone" Part "D" plans, you are
paying the first $310 of annual drug costs, and then 25%
of the next $2,520 ($630). After that, you will pay
100% of the next $3,610. This is the doughnut hole. (see
chart) How fast you reach this expenditure level is
determined by what your pharmacy bills your
insurance company, not what the insurance company pays
your pharmacy. If you are using generics, it will take
much longer to reach the doughnut hole than if you are
using brand name drugs.
(By
the way, this is also a good time to go over your
medications to determine if you still need every one of
them. Over time, medications are prescribed that should
be given for a limited time, but they are never stopped.
Several doctors, including your specialists, may have
written prescriptions that just keep refilling
automatically long after their need ends. Doctors are so
busy these days, that many overlook this. Make them
look.)
(3)
3-a
Go online to see if you you qualify for
Federal help with your Medicare expenses.
3-b
Go online, ( click your state on the
map at this
page) or call your state's agency on
aging, or the equivalent department, to determine if you
may actually qualify for additional state prescription help.
There is a lot of it out there. My state, Pennsylvania,
has 2 tremendous plans for couples earning less than
$31,500, and individuals below $23,500. You may be
passing up help that is staring at you. See our
"Surviving the Doughnut Hole" page for 14 ideas on
dealing with the doughnut hole.
(4) Let's assume that you looked over your
paperwork, and decide that you may have made a Medicare
Advantage
mistake. Now there are two choices: live with it until
next year (changing to something else between November
15 and December 31, 2008), or switching NOW to a
Another Medicare Advantage Plan, occasionally
called Medicare Health Plan, and also called
Medicare "C". (see
simple description) Open enrollment has not
ended for these plans. Open enrollment for Medicare
Advantage plans goes until March 31. This plan is
not administered by the government, but is handled by
private insurance companies. It combines Medicare A, B
and D. There are a wide variety of plans, and types of
Medicare Advantage Plans.
If you take a number of
prescription drugs, however, it gets more difficult to
choose. Certain plans might cover some of the drugs you
need but not all of them. But there are a number of
resources to help you choose.
Medicare Advantage Comparison Tool enables you to enter
your drugs, for your area, and determine which plan
makes the most sense for you.
Be
aware that if you switch to a Medicare Advantage Plan,
you must review much more than just the Part "D" portion
of the policy. That insurance carrier takes over your
"full care", and provides the features of Parts A, B,
and D. Study which doctors, hospitals, and other types
of care are included with the policy. Medicare pays the
Medicare Advantage insurance provider around
$650/month for every month you are in their care,
whether you need them or not.
We
hope all of this adds to your options, and not to your
confusion, If questions remain, you can always search at
www.medicare.gov, or call 1-800-MEDICARE. There may
also be a state representative available to give you
some help.
So what was my choice with Medicare and/or Part "D"?
I
opted for a very different Medicare Advantage plan this
year. My premium for last year's policy went to $76/mo.,
and the benefits were severely reduced. This year I have
gone to Highmark-Freedom Blue PPO. There are NO monthly
premiums, but I do have a $1200 annual deductible on the
larger expenses. My premiums alone would have been $912
under my old plan, and co-pays would have pushed it
quickly over $1200 if I needed any hospital or lab
related care. We'll see how this works. I am a
government-created gambler; I gamble on what I will need
during the next year. What a system. I have no
deductible in the drug portion of the program, and will
pay $7/mo for generics and more for brand names. There
is no donut hole coverage, but I found that I did not
reach the donut hole last year.
A
final comment. I think it is obscene that our government
puts us through this traumatic, risky, confusing
process. I totally support a "single-payer" system, run
by the highly competent Medicare section of the
Department of Health and Human Services. They can
administer the program more cheaply, and would have huge
negotiating power with drug and other suppliers. The
only thing standing in the way has been Congressional
backbone, and Presidential consent. Insurance and drug
lobbyists have wielded enough power to control these
programs up to this point. Until it is changed, we
must sift through this program as best we can. Best
wishes.
You may also
want to read:
Medicare Advantage open season and
I'm Falling into the Doughnut Hole
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