Don't be confused by mail on Medicare

Posted Friday, Nov. 08, 2013  comments  Print Reprints
Choosing Medicare coverage •  Open enrollment runs through Dec. 7 • If you have Original Medicare and a supplemental plan (often called Medigap) and you’re happy with your coverage, you do not need to make a change. •  If you have a Medicare Advantage or Part D plan, you should review your coverage options, because plans can change costs and benefits every year. •  Read your Annual Notice of Change, which you should have received from your plan by Sept. 30. It will list changes, such as premium and co-pays, and compare the benefits in 2013 with those in 2012. •  If you decide to enroll in a new plan, do so by calling 800-MEDICARE rather than the plan itself. •  If you are considering switching Part D coverage, don’t choose solely by the price of the plan. See if the plan you’re considering covers all your medications. Also, see if the plan requires special permission before it will cover your medication (such as prior authorization, step therapy, or quantity limits.) Source: Medicare Rights Center

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With all the talk about problems with the federal healthcare exchanges dominating headlines, it’s easy to forget that it’s also open enrollment season for an even bigger federal healthcare program — Medicare.

The mailboxes of 49.4 million Americans on Medicare (including 3.2 million Texans) are being jammed with marketing solicitations from insurers pitching their plans. Fortunately, there are a number of places people age 65 and older or who are disabled can go to get answers to their questions.

The good news is that monthly premiums and deductibles of those on original Medicare did not rise for 2014, according to the Medicare Rights Center. The Part B premium for most households remains at $104.90 per month, and the Part B deductible remains at $147. (There’s typically no premium for Part A, which covers hospitalization.)

“Provisions advanced through the Affordable Care Act (ACA) are successfully curbing Medicare spending growth, producing tangible results for people with Medicare,” said Joe Baker, president of the Medicare Rights Center.

The ACA will also shrink the so-called “donut hole” in Medicare drug coverage down even more in 2014 until it disappears completely in 2020, said Bob Moos, spokesman for the southwest regional office for the Centers for Medicare and Medicaid Services.

Next year, when out-of-pocket and insurance drug payments reach $2,860, Medicare recipients will receive a 53 percent discount on brand-name drugs and a 28 percent discount on generic drugs until drug coverage totals $4,450, when full coverage begins again, Moos said.

Moos said a program called Extra Help is available for drug costs, as well as Medicare premiums. At present, 37 percent of Texans in Medicare receive the financial support.

“It’s based on a limited income, but it’s worth checking out on whether you qualify,” he said.

Co-pays under the Extra Help program are just $2.55 for generic and $6.35 for brand-name drugs, Moos said.

Medicare Advantage programs in Texas, another option for Medicare-eligible recipients, are constantly tweaking their plans, so it’s good to compare annually. There are 30 Advantage plans available in Tarrant County, including 23 with drug coverage. Of these plans, 10 with drug coverage and six without drug coverage add no cost to the $104.90 base premium, Moos said. For those plans with an added cost, the average is $32.60 a month, up just $1.64 from last year, he said.

But premium shouldn’t be the only factor in selecting a plan, Moos said. Look at co-pays and whether your prescription drugs and doctors are included in the plans, he said.

Determining the right plan can be daunting, said Christina Bartha, community liaison for the Area Agency on Aging, part of United Way of Tarrant County.

“It’s overwhelming for our clients,” she said. “With all the mail they are receiving, they can keep it all and bring it to one of our benefits counselors. We can sift through and see what’s important.”

The agency’s benefits counselors then go to through the plan finder with the client at to find the best plan. Bartha said clients should bring a list of medications and doctors they wish to keep as well.

The service is free and there is no income limitation, Bartha said. Caregivers and children of those on Medicare can also have one-on-one sessions with the counselors, which offer the service in English and Spanish. To make an appointment, call 211.

Moos said Medicare also has a help line, 1-800-MEDICARE, (800-633-4227) available 24/7.

Insurers and financial planners also offer help sessions in choosing a Medicare plan.

Julie Rosenthal, a certified financial planner in Fort Worth, is holding a free seminar for current and future Medicare enrollees at 6:15 p.m. on Nov. 14 at Colonial Country Club.

“We are not talking about specific plans, but we are discussing all the options under Medicare,” she said.

Rosenthal said it’s important to remind seniors that the age for enrolling in Medicare is still 65, while the age for enrolling for Social Security has changed (for those born after 1943, full retirement age is now 66, and for those born after 1959 it’s 67). If you miss your window for Medicare enrollment, (three months before or after your 65th birthday) Medicare premiums could cost you more for the rest of your life. Part D also has potential penalties for late enrollment.

United Healthcare has opened up a storefront devoted to Medicare questions in Ridgmar Mall and a kiosk at La Gran Plaza in Fort Worth as part of a nationwide outreach project for the insurer, said Lindsey Edwards, agent manager for the insurer.

“A lot of Medicare beneficiaries are not wanting an agent coming to their home any more, and we see a lot coming to group meetings, so we decided to open up a store,” she said. “We were planning to open it up just as a pop-up store during the enrollment season last year. But we had such an overwhelming response, we decided to keep it open year round.”

Teresa McUsic’s column appears Saturdays.

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