Senior Citizens Have Until December 31 to Make
Changes in Medicare Coverage
Health plan costs are going up in 2009 and changing
plans could save big money says Medicare Interactive
Dec. 11, 2008 – In the wild rush to the holidays,
senior citizens should not forget that the door is open to make changes
in Medicare – health plans or drug plans - until the end of the year.
From November 15 through December 31, during the
Annual Coordinated Election Period, seniors can
change to another Medicare private health plan or to Original Medicare,
and add, drop or change Medicare drug coverage (Part D). The new
coverage will start January 1, according to Medicare Interactive,
a newsletter from the Medicare Rights
Center.
Medicare’s drug benefit (Part D) is outpatient
prescription drug coverage for anyone with Medicare. Enrollment is
optional; whether you should take Part D depends on your current
coverage and costs. You are generally limited in
when you can change your coverage (this is known as “lock-in”). The ACEP
is the time of year when everyone with Medicare can make any change they
like.
Part D coverage is available only through private
companies. If you want this coverage, you have to choose and enroll in a
private prescription drug plan.
You must pick a plan that works with your Medicare
health coverage. People who have Original Medicare can enroll in a
“stand-alone” plan, which offers only drug coverage. Most people who get
their Medicare benefits through a Medicare private health plan—such as
an HMO or PPO—must get their drug coverage as part of the health plan’s
benefit package (there are a few exceptions).
Premiums, annual deductibles, copayments, covered
drugs (formulary) and participating pharmacies vary from plan to plan.
And most plans change their costs and benefits every year, so even if
you are happy with the plan you had this year, it is important to review
your options to make sure you will be in a plan that best meets your
needs in 2009.
You can compare stand-alone prescription drug plans
by going to the Medicare web site,
www.medicare.gov, and clicking on “Medicare Prescription Drug
Plans—2009 Plan Data.” You can enter the medicines you take and
pharmacies you use, and this plan finder tool will estimate your monthly
out-of-pocket costs in different plans.
You can also call 800-MEDICARE
to get information about the plans that are offered in your area. Always
call the plan to verify information before you enroll. The plan finder
and 800-MEDICARE can only give you an estimate. You will want to verify
coverage, costs and restrictions. Also, keep in mind, that if your drug
needs change throughout they year, your costs will also change.
Another source of help is your State Health
Insurance Assistance Program (SHIP) office. SHIP counselors can work
with you to select the plan that works best for your particular needs.
To find the number for your SHIP, call 800-MEDICARE.
If you are considering
changing your health coverage as well as your drug coverage, make
sure to look at all the costs, not just the premium. Make sure the
health coverage you choose will cover the doctors, hospitals and
pharmacies you prefer to use at a cost you can afford.
If you decide to switch plans, you should enroll in
your new plan without disenrolling from your old plan.
You can change plans as many times as you need
during the ACEP, and your last choice will take effect January 1.
However, to avoid enrollment problems, it is best to make as few changes
as possible. It is best to enroll in your new plan by calling
800-MEDICARE, rather than through the plan itself. You will be
automatically disenrolled from your old plan when your new coverage
starts.
As mentioned above, enrollment
in a Part D plan is optional, but if you do not enroll in Part D when
you first become eligible and you choose to enroll at a later date, you
may have to pay a premium penalty. (The premium penalty will be 1
percent of the average national premium for every month you delay
enrollment.)
You will not have to pay a penalty if you have had
“creditable coverage”—coverage considered as least as good as the
Medicare drug benefit—and were not without that coverage for more than
63 days when you enroll in Part D.
You can also avoid the penalty if you
qualify for Extra Help, a federal program that helps pay for most of the
costs of prescription drug coverage. You can apply for Extra Help
through Social Security.
Medicare Part D Costs for 2009 Going Higher
You should be aware that your Medicare private drug
plan (Part D) costs will be changing next year. At the end of each year,
it is important to review your Medicare coverage to make sure that it
will still cover your health care needs at a cost you can afford in the
coming year. Knowing the new rates will help you avoid surprise charges
that could be a barrier to getting your health care.
Part D (Outpatient Prescription Drug Insurance)
covers drugs you buy at the pharmacy.
There is no Original Medicare
option for Part D—coverage is available only through private plans,
either stand-alone (Part D only) plans or as part of a Medicare private
health plan that includes prescription drug coverage. Each plan has its
own list of covered drugs (formulary) with different costs.
Part D is
optional, but if you do not enroll when you are first eligible, and you
do not have other coverage that is considered to be as good as Medicare
drug coverage, you may have to pay a premium penalty when you do enroll.
(You will not have to pay a premium penalty if you qualify for Extra
Help—federal assistance paying for Part D—even if you are doing so after
you were first eligible).
Part D plan costs change every year and each
private plan has different costs, so check with plans in your area to
find out what you will pay. With most plans you pay a monthly premium
and part of the cost of each prescription (copayments or coinsurance)
until total drug costs paid by you and the plan equal $2,700 (for most
plans) Then you may have to pay the full cost of your drugs during the
coverage gap, or “doughnut hole”). If you spend $4,350 in 2009 in
out-of-pocket drug costs, you will then pay no more than 5 percent for
each prescription (plus the premium). If your income is very low, you
can get Extra Help to pay for most of these costs.
Premiums
$30.36/month
national average (Every plan has a different premium.)
Deductible
Up to $295
annually (Plans can choose to have a lower deductible)
Coverage Gap
Threshold
$2,700 (The
amount that you and the plan must spend in total drug costs
in most plans before you will hit the coverage gap.
Catastrophic
Coverage Limit
$4,350 (The
amount of money that you must spend out-of-pocket before your
drug costs go down significantly for the rest of the year.)
To read more about how to choose a Part D plan that
best suits your needs, learn more about the costs and coverage under
Medicare Parts D, or to find out how to qualify for a Medicare Savings
Program, log on to Medicare Interactive at
www.medicareinteractive.org. Medicare
Interactive is a resource provided by the Medicare Rights Center, the
largest independent source of health care information and assistance in
the United States for people with Medicare.
Keep up with the latest news for senior citizens, baby
boomers
Medco offers free guide - ‘What's
Your Gap? Three simple steps to make the most of your Medicare Part D
coverage and delay the Coverage Gap’
You can compare stand-alone prescription drug plans
by going to the Medicare web site,
