Teresa McUsic

Time for seniors to compare Medicare plan options

By Teresa McUsic

Senior citizens can review their health insurance options during annual open enrollment for Medicare.
Senior citizens can review their health insurance options during annual open enrollment for Medicare. Fort Worth Star-Telegram

It’s time once again for the 3.2 million Texans with Medicare to consider their options.

Open enrollment continues through Dec. 7, a time for Medicare recipients to look over their plan choices to make sure they have the best fit for their pocketbook and healthcare coverage.

“Even if you are satisfied with your daily coverage, you owe it to yourself to check out the options,” said Bob Moos, spokesman for the regional office for the Centers for Medicare and Medicaid Services. “Some plans have adjusted their out-of-pocket costs and benefit packages for next year. Shopping around may save you money or improve your coverage.”

Moos said insurers are required to send a letter notifying policyholders of any major changes in their plan, but those letters don’t provide information on other offers. However, a Medicare handbook specific to Texas plans has been mailed to all policyholders in the state with details listed in the back, so seniors can compare.

Tarrant County 2016 Medicare options include 53 Medicare Advantage plans, an alternative to original Medicare. Monthly premiums range from zero to $99 with deductibles ranging from zero to $1,000.

Moos said the average premiums for Medicare Advantage plans in 2016 dropped 31 cents to $32.60 per month from this year.

Twenty-three Advantage plans include drug coverage. Those recipients who don’t have drug coverage or use original Medicare can choose from 25 Part D prescription plans in Texas. Monthly premiums for Part D plans next year range from $18.40 to $163, with deductibles ranging from zero to $360.

Most important to deciding on either an Advantage plan with drug coverage or a Part D plan is how your current prescriptions are covered by the insurer. You can enter your drugs into Medicare’s online plan comparison tool, at www.Medicare/find-a-plan, and find out how much will be covered and what you’ll have to pay out-of-pocket.

Those who are uncomfortable using an online tool can make an appointment with a benefits counselor from the Area Agency on Aging for one-on-one sessions. Last year, the agency conducted close to 200 Medicare benefit assessments, in addition to education sessions throughout the open season.

A five-star rating system for the plans, available on the comparison tool, has helped elevate customer service since it was implemented, Moos said. About 65 percent of Medicare Advantage enrollees are now in health plans with four or more stars, a significant increase from 17 percent in 2009, he said.

In Tarrant County, four Advantage plans and four Part D plans have been rated with four stars.

“The star rating system has indeed served as an effective incentive for insurers to compete with price and customer service,” Moos said.

The stars are based on customer feedback to the agency on member experience, complaints and other factors like pricing accuracy.

For those who have trouble paying monthly premiums for Medicare, there is a program called Extra Help, which can be obtained through the Social Security Administration.

To qualify, annual income can’t exceed $17,655 for singles or $23,895 if married. Also, your resources can’t exceed $13,640 as a single or $27,250 if married. Savings and investments count as resources, but homes, cars and personal belongings do not.

Thirty-four percent of Texans with a Medicare drug plan get Extra Help with coverage, Moos said. Generally, they will pay no more than $2.95 for generic drugs and $7.40 for brand-name drugs next year.

Also, the so-called “doughnut hole” — whereby policyholders who meet a certain level of drug benefit then must pay out-of-pocket until another level of spending is met — continues to close under the Affordable Care Act. Since 2010, the phased-in decrease has saved nearly 10 million Medicare beneficiaries more than $17.6 billion on prescription drugs. The hole will be closed completely in 2020.

Teresa McUsic’s column appears Saturdays. TMcUsic@SavvyConsumer.net

Getting help

Information sessions: United Way of Tarrant County’s Area Agency on Aging has three upcoming information sessions on finding a Medicare plan. The sessions are Nov. 7, 11 a.m.–12:30 p.m., Edgecliff Village Community Center; Nov. 10, 2 p.m.-7 p.m., Will Rogers Memorial Center, Fort Worth; Nov. 20, 10 a.m.-1 p.m., Grapevine Recreation Center.

By phone: The Area Agency on Aging provides one-on-one Medicare plan advice via phone, in person or at your home. Call 817-258-8125 and leave a message to make an appointment. Medicare also has a help line, 800-633-4227, available 24 hours a day, seven days a week in several languages.

Online: Medicare offers an online service to compare plans at www.medicare.gov/find-a-plan. Search by zip code or Medicare number and name. Enter drugs used for best cost estimates.

What to have on hand: A list of prescriptions including dosage, frequency taken, pharmacy type (retail or mail order) and pharmacy name and address. Also need Medicare card and any other health insurance or assistance program. Medicare Advantage clients should have a list of insurance carriers their doctors will accept to stay in network.