Time To Review Your Medicare, MAs, and Part D Plans

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Thinking About Your Medicare Advantage Plan and Part D Plans

“A word to the wise” – take time to review your personal situation, your Medicare Plan and MedicareRX Part D prescription drug plans. People on Medicare have an Annual Enrollment Period from 11/15 to 12/31. You can make changes in these Medicare Advantage and Part D Plans during this time period. Some would say that all of this is so confusing as they get bombarded with flyers and ads.

To simplify Medicare medical coverage; people have Original Medicare or they have a Medicare Advantage Plan (MAs). People who have Original Medicare should buy a Medicare Supplement (also called gap-filler). Gap-fillers are standardized so that the benefits between all companies offering these plans are alike (e.g. Plan F is the same as Plan F in another company). Other differences between gap-filler companies include the insuring company service, size, premium, value added services and stability, but one major feature remains constant – you can go to any doctor in the US that is a Medicare Provider. That means no network restrictions, and no asking providers if they will accept the terms and conditions of your plan. Having Original Medicare and a Medicare supplement offers you the most flexibility, but carries a higher premium than most Medicare Advantage plans (MA).

MAs are offered by private insurance companies and provide coverage at least as good as Original Medicare. MAs offer substantial coverage for less premium and are available for most people within the insurance company’s coverage area. MA plans will, most likely, have co-pays for such things as doctor’s visits and hospital stays. These plans have substantial differences from company to company and may change benefits and premiums annually. Be sure to review the “Summary of Coverage” and Annual Notice of Change” (for current coverage changes) for benefits, limitations and exclusions carefully.

As you review MA plans it is of utmost importance to know if your providers are in-network or would accept the terms and conditions for payment by this plan. Also consider whether or not you would seek medical care or diagnosis at Mayo Clinic, Barnes, Cleveland Clinic or any other diagnostic or specialty provider. These providers may or may not accept a specific MA plans.

Most MAs include prescription coverage. Medicare gap-fillers do not. Most importantly, this writer would urge all who are on Medicare to have creditable prescription coverage. This could be coverage from your MA Plan, from present or past work, or the VA

If you have purchased or plan to purchase a stand-alone Medicare Prescription Plan, it would be wise to review your current plan. Like MAs, MedicareRX Plans can change coverage, the drugs they cover and change how drugs are covered every January 1st. Therefore, a drug that was covered in 2010 might not be a covered drug with that company in 2011. In fact, it is said that there are more changes in MedicareRX plans from 2010 to 2011 since the inception of the program.

What’s the bottom line? It’s wise to review the prescriptions you take, the drug plan and MA you have, yearly. Now is that time, and if you wish to make any changes you can during the Annual Enrollment Period. Note: it is best to make any changes prior to 12/15 to hopefully avoid any glitches.

People on Medicare with incomes below $27,610 (couples $36,635) should look into the Illinois CaresRX program. This state program helps people on Medicare with limited incomes pay for their prescription drugs. Most importantly, if you qualify for Illinois CaresRX you should have a MA or Part D plan that coordinates with this program. (most plans do not coordinate)

Written by

Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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