Alex Wong/Getty Images
In this file photo, Center for Medicate & Medicaid Services' Web Site Project Management Director Ana Nunez-Poole (R) helps Medicare recipient Gladys Parrish (L) to compare Medicare-approved drug prices on the internet May 3, 2004 in Washington, DC. Medicare’s annual enrollment period for 2013 opened this week.
Medicare’s annual enrollment period opened this week, allowing two million beneficiaries in the five-county Greater Los Angeles area the once-a-year opportunity to make changes to their 2014 Medicare coverage.
And while things this year may seem more confusing — what with the advent of the Affordable Care Act (ACA) or “Obamacare” – nothing really changes for Medicare beneficiaries, beyond some expanded coverage, says David Sayen, regional administrator with the Centers for Medicare and Medicaid Services.
Despite this, and due to widespread confusion about what the ACA requires, many Medicare beneficiaries mistakenly believe they are required to enroll for insurance under Covered California, the state-run health insurance marketplace.
“What they do need to do,” Sayen says of Medicare enrollees, “is review their Medicare coverage.”
Taking the time to thoroughly read through your health plan, even one that you're happy with, is key to making sure you're not caught off guard by changes that no longer cover the treatments you need, the doctors you prefer or the prescription drugs you take.
So where do you start?
Here are answers to nine frequently asked questions with links to resources to help you better navigate through your Medicare choices.
1. How long does Medicare open enrollment last?
It started Oct. 15 and lasts through Dec. 7.
2. What are my choices for Medicare coverage?
The main choice is between the two categories of Medicare health plans: Original Medicare, which is the default enrollment category that’s managed by the federal government and Medicare Advantage Plans, which is a category you can opt into. This category includes a variety of plans run by private companies, such as Kaiser Permanente and Heath Net. Typically, these plans make annual changes. If you’re enrolled in one of these plans, you’ll get a notice outlining all the changes. Make sure to carefully read them. “Sometimes it pays to switch,” Sayen says.
3. What is Original Medicare?
If you have this plan, you can see any doctor or go to any hospital nationwide that accepts Medicare. There are limits on what a provider can charge you, and you will be expected to pay part of the cost for each service. CMS advises those with Original Medicare to consider supplemental insurance from an employer or from a “Medigap” policy designed to bridge the gap between what Medicare pays and your out-of-pocket costs, which, depending upon the procedure, can be high.
Original Medicare doesn't include a drug plan, so enrollees must choose a separate Prescription Drug Coverage plan ("Medicare Part D"), which is provided by private companies.
4. Do I need to do anything in order to stay in Original Medicare?
Nope. If you're content with your Original Medicare coverage, you can sit tight as there are no significant changes to consider, Sayen says. However, because Original Medicare doesn't include a drug plan, it's wise to review your Part D drug plans as the medications they cover, the pharmacies they work with and the premiums may have changed.
5. What are Medicare Advantage Plans ("Medicare Part C")?
This category includes HMOs, PPOs and a slew of other plan options provided by private companies. Most Medicare Advantage Plans include drug coverage. If you're considering this option, you'll have plenty of plans from which to choose. The average premiums for these private plans will climb about five percent in 2014, from $25.89 a month to $27.04 a month, Sayen says.
6. Do I need to do anything in order to stay in my existing Medicare Advantage Plan?
If it's working for you, make sure to confirm that any changes in the plan aren't deal breakers for you. If your plan is among the few that doesn't include prescription drug coverage, it's important to review any changes to your drug plan and, if necessary, choose another. Also, unlike Original Medicare that travels wherever you go in the United States, Medicare Advantage plans may not be accepted in all regions. So if you take up residence elsewhere during part of the year, make sure your plan will cover you there.
7. What are Medicare Prescription Drug Plans (“Medicare Part D”)?
These plans are offered by private insurance companies and approved by Medicare, to provide coverage in conjunction with Original Medicare (which doesn’t provide drug coverage) and with those handful of Medicare Advantage Plans that also don’t provide drug coverage.
One giant caveat: If you’re enrolled in a Medicare Advantage Plan that does provide drug coverage and if you also enroll in a separate prescription drug plan, you will be dropped from your Medicare Advantage Plan and enrolled instead in Original Medicare. So be sure you check before making any moves.
And like the other plans, you’ll want to check your drug plan to make sure any changes still fit your personal needs. “Your medication needs may have changed, your pharmacy may have moved away,” Sayen says.
8. Is there help if I can't afford my Medicare Prescription Drug Plan ("Plan D") costs?
Yes. It's called the "Extra Help" program. To qualify for help with monthly premiums, co-pays and deductibles, you must be receiving Medicare and meet certain income and asset tests. "People who qualify for this save about $4,000 a year," Sayen says. "So it's really a significant amount of money." Average premiums for 2014 will be about $31 a month up from $30 a month in 2013, he says.
9. Help! Can someone guide me through all these Medicare choices?
Yes. Check out the Medicare webpage. A few easy clicks allows you to compare Original Medicare to those plans offered by Medicare Advantage, complete with the Medicare Plan Finder that allows you to compare the premiums, deductibles and co-pays of each plan, as well as how many stars the plan received under Medicare's Five-Star Ranking System. The Medicare Interactive also provides a thorough, easy-to-follow resource online.
Prefer a more personal touch? Call 1-800-MEDICARE (1-800-633-4227) for the Health Insurance Counseling and Assistance program that provides trained volunteer counselors (most of whom are themselves Medicare beneficiaries) in your area who will help you evaluate your medical and drug plan needs. “They’re volunteers,” Sayen says, “and they’re able to sit down with you in person and walk through what your needs are and help you make that decision.” Or you can speak with representative by phone, seven days a week, 24 hours a day. And because these folks are contractors and not employees of the federal government, you’ll get your questions answered even during the occasional federal government shut down.