Posted : 11/01/2011
It's that time of year: fall is creeping into winter and the holiday season, which means it's open enrollment for Medicare. If you're an adult child helping your parents or older relatives through the process, you may have already felt guilty about screening your calls.
To help, we've done the research for you and compiled it into a handy guide to everything you need to know about navigating Medicare open enrollment. With our primer as a resource, you can relax and enjoy Thanksgiving with your family instead of explaining what a formulary means and discussing health insurance.
The first thing you need to do is remind Mom and Dad (if they're 65 or over or disabled) that the open enrollment period for Medicare is earlier this year than in years past. Open enrollment ends Dec. 7--not at the end of the year as it has in prior years. It also started earlier this year, Oct. 15, so time is getting short.
Your parents should use the time to review their Medicare options and, if they want, to make any changes.
During this time, your parents can change from Original Medicare to a Medicare Advantage Plan, most of which are HMOs run by private companies. Or, they may switch from a Medicare Advantage Plan to Original Medicare. If they choose Original Medicare, they likely will need to buy supplemental insurance to pay their co-insurance and deductible costs. (Medicare only pays 20 percent of the doctor's approved fee.) If they choose Original Medicare, they also should decide now whether they want to keep or add drug coverage under Part D. Many Medicare Advantage Plans include drug coverage.
Your parents may be happy with the health insurance coverage they have as well as what it costs, says Fred Riccardi, director of programs and outreach for the Medicare Rights Center, a nonprofit counseling organization in New York. "They don't necessarily need to change anything," Riccardi says. "But they should at least review the options they've chosen to be certain it's what they want."
Here's a list of questions your parents or relatives should ask when doing their review, and where they can find answers.
A: By now, you should have received an annual notice of rate changes from the Medicare supplemental insurance or Medicare Advantage Plan in which you're enrolled. "It will describe what the plan costs are going to be for 2012 and if they are making any changes," Riccardi says. If you haven't received a notice, call your health insurance carrier and ask for one.
A: Here are three good places to start:
A: Only about 25 percent of those eligible for Medicare choose a Medicare Advantage Plan, Riccardi says, although the numbers are expected to be slightly higher for 2012.
The biggest advantage to a Medicare Advantage Plan is that the cost is usually lower than for a Medigap plan. However, Medicare Advantage Plans often restrict your options in terms of the hospitals you can use for treatment and the doctors you can see.
If you choose a Medicare Advantage Plan, check to be sure the hospitals and doctors you go to regularly are part of its network. It's a good idea, Riccardi says, to ask your doctors for opinions about the plan and whether they believe it's a good fit for you, particularly if you have an ongoing medical condition.
Remember, price is not the only important consideration when choosing the plan that's right for you, Riccardi says. For example, if you travel a lot, you may not want a supplemental insurance plan that restricts your choice of doctors and hospitals.
A: There is a lot to think about when it comes to Medicare drug coverage, Riccardi says. As with choosing a plan, cost is just one consideration, but not the only factor that should be part of your decision.
Even if you're not taking a lot of prescription drugs now, consider joining a Medicare drug plan because you will pay a late enrollment penalty if you choose to join later, Riccardi says. You will pay this penalty as long as you have a Medicare drug plan.
When considering which drug plan is right for you, ask these questions of your pharmacist and plan provider:
The government offers a good resource for making decisions about drug coverage: Medicare Prescription Drug Coverage: How to Join a Medicare Drug Plan.
A: Another good resource is your area agency on aging. Many area agencies on aging across the country provide free programs and counseling sessions for people who have questions about Medicare enrollment.
The National Area Agencies on Aging can help you find the local agency closest to where you live--there are 650 in the country.
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