If you’re on Medicare, there’s a good chance that you are spending more money than you need on health care and prescription drugs. This happens every year because senior Americans and their families don’t take the time to shop around and make needed changes. Change can be scary for everyone, but if you can save money – or get better coverage for the same cost – it’s worth the effort.
During the Fall Open Enrollment Period for Medicare – Oct. 15 through Dec. 7 – Medicare beneficiaries have four options:
- Change to a different prescription drug plan (Medicare – Part D). If you have original Medicare, there are 25 drug plans available to Arkansans this year. Premiums are about the same or slightly higher than last year. The average, basic plan premium is $32.50 a month. Premiums range from $11.40 to $132. The drugs that each plan covers (called a formulary) change frequently so be sure your drugs are covered. Also, check that the plan includes your preferred pharmacy in its network.
- Leave original Medicare and get your health care from a private Medicare Advantage (MA) plan. Some MA plans offer extra services (like vision and dental coverage), and most offer drug coverage. You will pay more for these extra services. Private insurance companies run the MA plans. MA plans must provide health benefits that are equal to or better than original Medicare. Depending on where you live in Arkansas, you may choose from three to 17 MA plans. Call Medicare at 800-633-4227 to get a list of plans available in your area. Then check the plan websites to decide which plan best meets your needs. Make sure the plan includes your doctors, hospitals, drugs and pharmacies in its network. You’ll pay more to use providers outside the plan’s network. If the MA plan you choose includes drug coverage, you do not need a separate Part D plan.
- Leave a MA plan and return to original Medicare. If you go back to original Medicare, you will also need to choose a stand-alone Part D drug plan. You may also want to buy a medigap policy that helps pay the costs that original Medicare does not cover. Medigap policies (formally called Medicare supplement insurance) are sold by private insurance companies to “fill the gaps” in coverage where original Medicare does not pay. Original Medicare pays its share, and the medigap policy pays all or part of the remaining costs, including co-payments, coinsurance and deductibles. Some policies pay for additional services not covered by Medicare. You pay extra for medigap coverage. Benefits for all medigap policies are standardized into 10 different policies. Be sure you understand the differences so you don’t pay for more services than you need. You do not need a medigap policy if you join an MA plan.
- Change from one MA plan to a different MA plan.
To save money and get the best benefits for your needs, look at more than monthly premiums. Compare costs for deductibles, co-payments and coinsurance costs. When considering a drug plan, make sure it includes your medications and in the dosages you need. Most plans charge more for name-brand drugs. Using generic drugs will save money unless your doctor has written your prescription for a name-brand drug. Be sure your drug plan will cover exactly what your doctor prescribes.
Take time to check your coverage
Even if you were satisfied with your coverage this year, you should review your options for two important reasons.
- Plans make changes in their benefits every year. Drug plans frequently change the list of drugs they cover.
- There’s a good chance you can save money. Research has shown that Medicare beneficiaries tend to stay with the first plan they choose year after year, even when another plan is less expensive or has benefits that would better serve their needs.
If you have an MA plan or a separate Part D plan, you should receive an Annual Notice of Change or Evidence of Coverage from your plan. Review these notices for changes in the plan’s costs, benefits and rules for 2016.
Medicare has an easy-to-use website called Medicare Plan Finder that can help you make the best choice. Go to Find A Plan to compare other plans with your current plan. It has important information about pharmacy networks, cost sharing and coverage rules. If you decide to make a change, this website will guide you to enroll in a new plan.
For a helpful list of questions to ask before switching to MA or Part D plans go to Medicare Interactive
You can also call Medicare toll free at 800-633-4227 at any time. A trained, objective counselor will help you evaluate and compare different plans.
Your “Medicare & You 2016” handbook can also provide guidance. Medicare sent you a copy in the mail. You can also read it online (and download a copy) at Medicare Arkansas’ eight Area Agencies on Aging (AAA) also provide free help from trained counselors who can meet with you face-to-face or over the phone. This advice is objective. You will make the choice after the counselors explain the benefits of each plan that meets your needs.
Another source of objective help is Arkansas SHIIP, the State Health Insurance Information Program (SHIIP). Trained counselors can provide in depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families and caregivers. In Arkansas call 501-371-2782 or visit SHIIP click here
If it’s difficult for you to pay for your drugs, and you have a limited income, you might qualify for financial help. “Extra Help” is a government program that reduces the costs you pay for your drugs – no more than $2.95 for a generic and $7.40 for a name-brand drug in 2016. Eligibility for Extra Help depends on your income and resources. To qualify, your income must be no more than $17,655 a year ($23,895 if you’re married), and your resources cannot be more than $13,640 ($27,250 if married). Resources do not include your home, cars or personal belongings, but do include savings accounts and investments.
To apply for Extra Help, visit Extra Help or call toll free at 800-633-4227.
There are just a few steps to find the best plan for your needs.
- Gather all your medication bottles, or make a list of each drug including name, what it’s for and dosage. You will need this to evaluate and choose a Part D drug plan as well as evaluate MA plans’ drug coverage.
- Make a list of your doctors, specialists, hospitals, pharmacies and other health care providers you use. Use this list to be sure they are included in the network of providers used by your Part D and/or MA plans. If you use providers out of these networks, you will pay more.
- Evaluate how well your plan met your needs over the past year. You may want to talk with your doctor about any procedures or new treatments you will need in 2016. Look at how well each policy would cover those future needs.
- Check the star ratings. Medicare Plan Finder includes star ratings that indicate the best and worst plans in your area. The star ratings will be updated by mid-October. A gold star indicates the best, five-star rated plans. If there’s a warning icon, it means that plan performed poorly over the past three years. The higher the number of stars, the better the plan performed in terms of:
- Level of care, such as how well it managed chronic conditions
- Screening for and preventing illness
- Making sure the patient has his medications
- Customer service and complaints
- Wait times for care
- Make your decision by Dec. 7. You have the right to make as many changes as you need between Oct. 15 and Dec. 7. The last change you make on or before Dec. 7 will be the plan that will go into effect Jan. 1, 2016.
- Enroll in your new plan through Medicare at 800-633-4227. This is the best way to protect yourself if you have problems with enrollment. Before you enroll with Medicare, confirm all the details about your new plan with the plan itself. Keep careful notes about these conversations, including the date and with whom you spoke.
- If you do nothing, your current plan will continue in 2016.
- Do not use the Health Insurance Marketplaces (or exchanges) that are set up for uninsured or underinsured Americans. They do not handle any Medicare services.