Figuring out Medicare plans isn’t simple. Like going to the dentist or getting the car repaired, it’s on that list of things we’d like to avoid as long as possible. But with open enrollment coming up, it’s time to stop procrastinating, whether you’re a Medicare newbie or want to re-evaluate your plan.
Either way, your life just got a little simpler. The National Council on Aging sponsored a webinar on September 18 about “Medicare Enrollment: What You Need to Know.” And its site, as well as the government Medicare site, has plenty of tools to help you tailor what you need to your exact situation – the most important thing to know about Medicare decisions.
Senior Planet listened in as the NCOA’s Brandy Bauer explained the details; we captured the highlights. (Click here to access the webinar slideshow.)
Skip this if you don’t need a crash course or refresher.
- Part A Medicare helps to cover hospital stays, skilled nursing, home health care and hospice services.
- Part B Medicare helps to cover outpatient services such as doctor’s office visits, outpatient care, home health care and some preventive services.
- Part A and B are often referred to as ”original Medicare.”
- Part C refers to Medicare Advantage plans, such as HMOs and PPOs. These are offered by private insurance plans that are Medicare-approved. The plans offer A and B coverage and usually drug coverage.
- Part D offers prescription drug coverage.
- Medicare Gap is supplementary insurance, sold through private companies. It’s designed to help cover costs not covered by basic Medicare – parts A and B.
New enrollment – when to enroll Knowing when to enroll is crucial to avoid penalties and lack of coverage, Bauer says. For instance, if you don’t enroll on time for Part B, the premium increases 10 percent for every 12 month period you could have had Part B but did not enroll. And that penalty is in place for as long as you have Medicare.
- If you are about to turn 65, your initial enrollment period is the 7-month window around your birthdate. You can apply 3 months before your birthday month, during your birthday month, or three months after it.
- If you are turning 65 and you enroll in Parts A and B, you have a six-month window to enroll in a Medigap plan, if you choose to.
- If you are working past age 65, check with your workplace’s benefit plan administrator to get specifics about your situation.
Why re-evaluate? Since plans change and so do your individual needs, experts say it’s a good idea to assess your plan every year. Few people switch plans during open enrollment, but doing so could save you money. The plan you pick during this year’s open enrollment will kick in on January 1, 2015.
When to change plans Open enrollment goes from October 15 to December 7. During this time, you can change plans, such as dropping original Medicare and choosing a Medicare Advantage plan. And you can change your Part D plan, drop it or add it.
How about Obamacare? One aspect of health care that often confuses people, Bauer says, is the role of the marketplaces set up under health care reform (“Obamacare”) to offer lower-cost insurance options. The Marketplaces do not affect Medicare in any way. None of the Medicare plans are sold through the Marketplaces. So there’s not need to access the marketplace websites when exploring Medicare options.
How to Find the Best Plans
You can find all plans available to you via Medicare’s personalized Find a Plan tool. By entering your information, you can compare coverage and see if the plan you are on still is best for you. Click here to visit Find a Plan.
The National Council on Aging has a Medicare QuickCheck tool. Fill in a form, and it will spit out a report with recommendations tailored for your situation. It’s a way to find out if you may be eligible to save on costs through subsidies or benefit programs.
When evaluating plans, think of the four Cs, Bauer suggests.
- Costs Don’t look just at monthly premiums, but the amount of co-pays, deductibles and other fees.
- Coverage Consider the services you may need and see how good coverage is. How does the plan rate under the Medicare star system (5 stars being best)?
- Convenience Can you get your regular medicines by mail order? Or at a nearby pharmacy? Are the medical offices you will go to nearby or an easy commute?
- Customer service How well are your questions answered?
Figuring Out Pros & Cons
MediGap If you decide to sign up for Medicare Parts A and B, some services still won’t be covered. These so-called gaps in coverage can add up, especially if you don’t have other insurance that helps to pay for the excess costs.
For instance, the hospital deductible for Part A is $1,216 a year for 2014; the annual deductible for Part B is $147 annually.
You can buy a Medigap plan from private insurance companies; most states offer 11 different plans. Costs vary widely. Click here to compare.
When choosing a Medigap plan, be aware that if the doctor you go to ”accepts assignment,” that means he or she will accept whatever the Medicare-Ok’d amount is. typically, your Medigap plan pays the doctor. If your doctor doesn’t accept assignment, you may need to pay ahead and submit claims to be reimbursed.
Medicare Advantage vs. Medigap Most people pay nothing for the Part A Medicare premium (if they or a spouse have worked and paid into Social Security for 10 years or more).
For Part B, most people pay $104.90 a month for the premium. Those making $85,000 or more/$170,000 for married couples will pay more.
If you then pick a Medicare Advantage plan, you may or may not need to pay a plan premium. For 2014, the average plan premium is $32.60, but the costs vary greatly among plans. There may also be an annual deductibles, copays for doctor’s visits and other services, and extra fees if you want to see a provider not in the network.
If you pick Medigap, costs vary. Click here for info.
Getting More Help
If you need more help, plenty of toll free lines and websites offer guidance.
- SHIPS stands for State Health Insurance Assistance Programs. Find yours here: shiptalk.org. The programs offer individual counseling and assistance.
- NCOA has an educational service to walk you through Medicare enrollment: mymedicarematters.org.
- The Medicare Rights Center is here: medicareinteractive.org and by phone, 1-800-333-4114.
- There are many comprehensive guides to Medicare basics; there’s a good one with info about online tools as well from the Texas Medicare Plan.
Got any Medicare know-how to share? Please add it in the comments below.