Medicare Open Enrollment is earlier this year—October 15 to December 7, 2011.

To save you money and angst, you need to reevaluate your Medicare coverage every year at Open Enrollment!
So let’s get started.
Quick Medicare Primer:

Original Medicare has 2 parts
Part A covers in-patient (hospital) costs-is free for anyone who worked for 10 years and contributed to Medicare through payroll deductions

Part B covers out-patient (doctor visits) costs-has a monthly premium that is deducted from your Social Security check

BUT KEEP IN MIND THAT MEDICARE DOES NOT PAY FOR EVERYTHING YOUR DOCTOR ORDERS AND MEDICARE DOES NOT COVER THE COMPLETE COST OF MEDICAL CARE

You can have just Original Medicare but you are then responsible for all of the medical bills that Medicare does not cover and you will have to pay full price for all of your prescription medicine … OR you can choose additional insurance coverage to help pay for these additional bills.

There are several choices to help cover some of the costs that Medicare does not pay and to lower the cost of your prescription drugs. To take advantage of any of these choices you must have both Medicare Parts A and B.

So here comes the confusing part!

Private insurance companies offer health insurance policies that pay for many of the charges Medicare does not pay for. These are called Medicare Supplement or Medigap Plans. There are 11 different types of plans to choose from. They vary in price and what they pay for.

In general, these are best if you several medical problems, or if you travel, or if you live in more than 1 area of the U.S. during the year, if you want to be able to choose your doctors or treatment facilities without dealing with a restrictive network.

Advantages of choosing one of these plans:

• You can go to any doctor who treats Medicare patients
• You do not have to have a referral to see a specialist
• You will not have to pay a copay when you see a doctor
• You can travel within the U.S. or live in more than one area of the U.S. and get medical care covered by your insurance

Disadvantages of choosing one of these plans:

• Medigap plans do not provide prescription drug coverage, so you must also purchase a Medicare Part D (Medicare Prescription Drug) Plan
• A Medigap plan plus a Medicare Part D plan can be more expensive than purchasing a Medicare Advantage (Medicare Part C) plan—see below

The alternative to adding a Medigap Plan plus a Medicare Prescription Drug Plan (Medicare Part D) to Original Medicare is to choose what is called a Medicare Advantage (Medicare Part C) Plan. These plans are also offered by private insurance companies and the number of plans available to you depends upon what state you live in.

Advantages of these plans
• They are often less expensive than adding Medigap plus a Medicare Prescription Plan (Medicare Part D) to Original Medicare
• These plans are all inclusive-they provide both medical and prescription drug coverage
• They must offer the same level of coverage as Original Medicare, and often have additional coverage—such as limited dental, eye care, and other services—available for an additional monthly cost or no additional cost

Disadvantages of these plans

• They are usually (but not always) HMO plans which means you can only to be treated by doctors in their network for the plan to pay for your medical care
• You will have to pay a copay every time you see a doctor or get a covered service
• If you need medical care outside of the area where you live, these plans only will pay for emergency treatment-you cannot see doctors out of your area

So now it is Open Enrollment:

So what does that mean?

Every year during Open Enrollment anyone who has Medicare—regardless of what type of a plan—should review plan(s) you had this year, look at the plans that are offered for the next year and choose to change your Medicare choices or stay with what you have.

During this time you can:

• Change from Original Medicare to an Advantage plan
• Change from an Advantage plan to Original Medicare
• Switch from one Medicare Advantage plan to a different Medicare Advantage plan
• Switch from a Medicare Advantage plan that offers prescription drug coverage to a Medicare Advantage plan that does not offer prescription drug coverage
• Join a Medicare Prescription Drug Plan (Medicare Part D)
• Drop you Medicare Prescription Drug Plan completely

Why is it important to reevaluate your Medicare coverage every year?

Very simply, things change!!

If any of the following have changed since last year at this time, you need to reevaluate your medical and drug coverage. If you don’t, you may be stuck with a plan that is more expensive or does not cover medical expenses you will need next year.

• Have the medicines you were taking changed?
• Do you have new doctors?
• Do you have a new diagnosis?
• Are you planning any surgeries next year?
• Are you planning to travel or live someplace else during part of the year
• Have you moved?
• Are the doctors you want to see no longer on your plan?
• Are you unhappy with the medical and/or prescription plans you had this year?

So how do you figure out which medical and prescription drug plans are available for next year and which is the best one for you?

• You can go to www.medicare.gov and use their site to evaluate next year’s plans
• You can contact your state Department of Social Services to see if they have a State Unit on Aging
• You can look online for a non-profit group in your area that helps people with Medicare questions
• You can ask a friend or relative to help you
• You can hire a Private Health Care Advocate to evaluate your current medical and drug status and match you with the best plan(s) for you for next year

However you do it …DO IT

Medicare Open Enrollment – Tis the Season

When the end of summer and the fall season beginning, it signals for those of us in health care that the season of open enrollment will be upon us. Open Enrollment is the time when employers give employees the opportunity to review their insurance benefits, and make decide to renew or make changes.

If you are a Medicare beneficiary the government gives you the opportunity to review your coverage options as well. This year the open enrollment begins earlier than prior years and ends earlier as well. The open enrollment period begins October 15 and ends December 7^th. Enrollees in “original” Medicare can move into a Medicare Advantage Plan during this time. Medicare Advantage enrollees can move into “original” Medicare.

Don’t miss this opportunity to review you current coverage and evaluate whether or not a different Medicare option is a better choice for you in 2012.  According to a recent survey done by National Council on Aging and United Healthcare, 46% of seniors have never shopped around for the best Medicare coverage. Medicare should have the 2012 options and pricing available on their website on October 1. Medicare Part D (prescription drug plan) options can also be changed at this time.

While a plethora of choices can be paralyzing for some, here are a few areas to review before looking at your options:

Ø      Have you have any new medical issues identified in 2011?

Ø      Are these issues likely to continue in 2012?

Ø      Have your medications changed in any way? This includes changes to frequency and dosage?

Ø      Do you have new medical specialists on your care team? If so, do they participate in Medicare? Do they participate in any local Medicare Advantage plans?

Ø      Are you pleased with your current coverage?

Ø      Have you moved or plan to move in 2012.

Taking the time to do your homework – understand your own needs, your budget and what your options may save you considerable dollars in 2012.

Confused? Overwhelmed by your choices? Get help! Each state has a  organization armed with  trained Medicare. Contact the local Area Agency on Aging office . Or, you can call Health Champion, we are in your corner!

Top 5 Mistakes You Can Make During Open Enrollment

Now that summer is ending and school is beginning, it won’t be long before the busy open enrollment season is upon us. While most of us don’t look forward to wading through benefits descriptions, it’s important to put those feelings aside and invest some thought in the process. Taking time to study your options now could not only save you money, but also affect your health care choices for the coming year.

5 Mistakes to Avoid when Choosing Your Health Coverage.

1. Buying on price alone. Finding affordable insurance is getting harder and harder, but buying on price alone is often a mistake. Your monthly premium may be low, but can you really afford that high a deductible? Buying a high deductible plan under the assumption that you are healthy and never need to use doctors is risky. Are you prepared to pay the deductible if the need arises? Can you afford the cost shares that may kick in after the deductible is met? If your employer offers worksheets or modelers for comparing the available plans, take advantage of them and do the math.
2. Not considering your family’s situation. Of course, you can’t predict everything that might happen, but you can look at your current health status. If someone in your family has a medical condition, you can take their care plan – upcoming tests, specialist visits, and medications – into account. You will also want to look at your values and attitudes. If you like to be in charge of your care, you might be willing to pay extra for a plan that doesn’t require referrals to specialists.
3. Not verifying your providers’ participation status with your health plan. Providers who are considered in plan have a contract. Contracts change and it is not unusual to have providers cancel participation with a health plan. Just because your provider was “in network” and “participating” last year doesn’t necessarily make it so this year. Call the health plan and call your doc to verify. Check your health plan’s website for an up-to-date list of participating providers.
4. Renewing into the same benefit plan design. Benefit plans change each year. There may be new plan limits and exclusions. Don’t assume nothing has changed. Pay particular attention to your prescription benefit. Drugs lists often change at the time of open enrollment – impacting the tier that drug is on and how much you will pay out of pocket next time you renew your prescription.
5. Not taking advantage of opportunities to offset cost sharing, if offered. A Flexible Spending Account lets you to put aside pre-tax dollars to use for eligible medical expenses. If you can predict some of your deductible and copayment expenses for the coming year (based on your health needs and the plan design you choose) and put them in an FSA, you can save around 25% on your out-of-pocket expenses by paying with pre-tax dollars.

Perhaps the most important thing you can do is to ask questions. If you don’t understand a benefit offering, ask your Human Resources department. If you’re not sure how much you spent this year, see if you can download your claim history from your health plan’s web site or request a report. Make an informed decision this fall, so you can use your plan with confidence in 2012.

Whether you’re one of the lucky folks who still have health insurance from your employer or you purchase insurance on your own, open enrollment is right around the corner. It’s a critical time in terms of choosing or renewing benefits, so approach with care and caution.

Here’s what it is:
An annual event, open enrollment gives you an opportunity to change your current health plan  or benefit options, such as dental or vision care. Once open enrollment is over, you can’t make any changes to your plan design for an entire year, unless there’s an IRS qualifying event, such as marriage, divorce birth, adoption, or death.

During Open Enrollment, examine your plan choices for the following:

1. The Network:  Compare your doctors and specialists  (along with your preferred hospital) with the plan’s list of network providers. Who’s in?  Who’s not? Can you live with that?  Are you allowed to use out-of-network providers and hospitals?  If so, what are the costs and prerequisites?

1. Cost Per Visit:  Look at monthly charges, deductibles, and co-pay requirements for doctor and specialist visits.  Do the math. If you see doctors often, you may want a higher monthly payment with lower co-pay; if you go occasionally, consider a lower payment and higher co-pay.
2. Prescription Coverage:  Basically, you want to compare plans in relation to the annual cost of all your prescriptions. Which plans have a separate prescription deductible? What about co-pays?  How much will you save with generics or ordering by mail?
3. Plan Features & Overall Coverage:  Think about the services and supplies you normally use;  now imagine the coming year and what you might need. Will you be traveling? Having surgery? Will you need short term rehabilitation and physical therapy? Does your plan require precertification? Are you covered anywhere in the U.S. or if you travel abroad?  Are preventative care and immunizations covered?  Of the plans you’re considering, which offers discounts for services like gym memberships? Is that important to you?

Choose your plan according to your needs — the ones you have now and the ones you envision for the coming year. You only get one chance each year to get it right. If you need help comparing plans and benefits, give Health Champion a call.  We’re here to make Open Enrollment easy on you.