by David Tesitor
HUERFANO, LAS ANIMAS AND COLFAX — Now is the time for Medicare beneficiaries to look at the plans they chose last year and decide if a review is necessary. Medicare’s open enrollment begins October 15 and goes through December 7.
Based on several changes providers made, one needs to consider looking closer at what they have. Every year, Medicare health and drug plans can make changes including cost, coverage, co-pays and what providers and pharmacies are in their networks.
Members enrolled in either a Medicare Advantage (MA- MAPD) or Prescription Drug Card (PDP) should have already received their new plan materials including Evidence of Coverage (EOC) and Annual Notice of Change (ANOC). If the company changes your plan, you should make sure the new plan still meets your needs for the following year. If you’re satisfied your current plan meets your needs for next year, then you don’t have to do anything.
Making sense of Medicare, the government-run health-insurance plan for people with disabilities and those age 65 and older, isn’t easy. The options read like alphabet soup, including Parts A and B (original Medicare), Part C (Medicare Advantage), and Part D (drug coverage). There are multiple options for people. The first options, and the most traditional, are Medigap policies, also known as supplemental insurance. They are private insurance plans which work with Original Medicare to help cover out-of-pocket costs and are used by about 20% of Medicare beneficiaries. With some exceptions, you’re only guaranteed a Medigap plan within the first six months of both being 65 or older and enrolled in Medicare Part B. After that, unlike with Medicare Advantage plans, you can be denied coverage based on your health. Medigap policies offer a wide range of plans which meet many people’s medical or premium needs. These plans usually require a stand alone prescription drug card.
The second option set includes the Advantage plans. In rural southern Colorado, choices have decreased for 2016. According to the Centers for Medicare Services, there are 24 Part D plans offered by 9 insurance companies. The choice of Med Advantage (MA) plans remain the same with three companies and only two companies offer a combined medical and drug benefit (MAPD).
In Colfax County, the choices are even more restricted. While there are 24 Part D choices, the Advantage and MAPD options are limited to two companies.
Across the country, some may find their plans have been cancelled. One can purchase a stand- alone drug plan and a stand-alone MA plan, with certain exceptions.
Changes beneficiaries will see in 2016 vary among companies but one thing is certain, premiums have increased, co-payments and out of pocket limits are higher. Concerning the Part D, one should look carefully at which drugs are covered under the plans they are considering for 2016 (check the plan’s formulary) and make sure the drugs you need are on the list. Also know the restrictions. Some drugs are covered but there may be a restriction like prior authorization or a quantity limit. Remember, if you choose a plan for 2016, you are basically stuck with it for the next year. Also consider there are a growing number of plans adopting a network pharmacy benefit. That means some pharmacies will be in your plan’s network and others will be out-of-network. You’ll pay more out-of-network so be sure to check the pharmacies near you participate with your plan. Mail order is still a covered option.
Open enrollment means people can join or make changes to a Medicare Advantage plan or a Part D prescription drug plan. If one wants to drop their MA plan and go back to original Medicare, now is the time.
To help with the myriad of choices, consider consulting with an independent broker who can show you all options and all plans before you make a final decision. You will not be charged for any advice provided. If you already made one, don’t worry, the final plan you choose prior to December 7, 2015 will be the plan you are assigned to.
