MEDICARE OPEN ENROLLMENT: HOW DO I DECIDE?

MEDICARE OPEN ENROLLMENT: HOW DO I DECIDE?

            Open enrollment for Medicare is October 15 – December 7 every year.  This is your opportunity to review your current plan, coverage’s and costs.  You need to determine whether to stay with your current plan or if you want to change to a new plan.

As much as you may want to rely on an insurance salesperson to direct you, many of the choices and decisions you need to make to determine the best policy are very personal choices – and most likely only decisions you can make.  It is startling to me to be shopping at the Dollar Tree (one of my favorites) and walk out and see a card table set up with someone trying to sell me a health insurance policy.  REALLY!!!!

You start by going to the website Medicare.gov.  When you enter the website, it provides options and you will want to select the one that states: Review your health and prescription drug coverage options.  The questions ask include:

1. Your home zip code.
2. What plan you currently have? For example, Medicare, a Medicare Plan (aka as an Advantage Plan), you don’t have a plan yet, or if you don’t know you have the option of stating I don’t know what plan I have.
3. The next question asks you to list all of your medications and dosages. The easiest place to find this information is directly from the container your medication comes in from the pharmacy.  If you do not have the container(s) you will need to call the pharmacy and ask them for a list or better yet, stop by the pharmacy and ask them to print you a list.  If you use more than one pharmacy Bonus Tip: one of your New Year’s resolutions needs to be to commit to one pharmacy.  Managing your prescriptions appropriately as well as one pharmacist reviewing your medications is an invaluable resource.  When you have a primary care physician as well as specialists prescribing your medications it is typically the pharmacist that can review the medications and look for concerns or issues you need to know and address with your healthcare providers.
4. Once you have entered in each of your medications and dosages, the next question asks for the name and address of your pharmacy. You can find the name and address of the pharmacy on the medication container.
5. Upon entering all of the above information the next screen allows you to apply a variety of filters, for example, limit plan premium, select star ratings, etc.… if you want to reduce the number of the choices.  Otherwise you may go directly to review the following:
   1. Prescription Plans (Part D) with Regular Medicare
   2. Medicare Health Plans (Medicare Advantage Plans) with Drug Coverage
   3. Medicare Health Plans without Drug Coverage
6. The options are listed and you can make a decision from the list. My list came up with over 40 choices – so my work to make a decision is still not done.

If you are on regular Medicare Part A and Part B, you may want to review your supplemental policy (if you have one).  While the monthly premium you have to pay for a Supplemental Health Plan is typically more expensive than you would pay for a Medicare Advantage Plan it often provides you more choices in healthcare providers and greater coverage towards payments, and covers co-pays, etc…  You usually get to select your healthcare providers and change healthcare providers whenever you want.  You can choose whether to use community physicians or the specialized University medical system.  You can choose the rehabilitation center you want or the mental health treatment center you want.  The gamble is whether you get sick or not.  If you get sick your premium will feel reasonable when you see what your care would have cost if you did not have the insurance coverage.  If you do not get sick, it feels like you wasted a year’s worth of premium payments that could have been used for something fun.

This is where the personal part comes in.  We all have to decide what our priorities are and how we want to spend our money.  The Medicare Advantage Plans often are less expensive on a monthly basis and include expanded coverage for items Medicare A and B do not cover.  Many Medicare Advantage plans have contracts with healthcare providers, limiting their plan coverage to those providers.  The contract may limit which hospital, rehabilitation center, mental health provider, physician, just about any type of health care provider you may use.  It is up to you to decide if you are going to be content with the limitations.  You will be “stuck” with the plan you have chosen until the next open enrollment period.

The Medicare Advantage plans may change their healthcare provider contracts at any time.  It is your responsibility to review their website and keep up to date on any changes.  Sometimes your healthcare provider will contact you and state after next month I am no longer part of your insurance plan.  When this happens you have to decide whether to pay for out of network coverage or change to a healthcare provider covered by the plan.

Some people can live with the changes, go with the flow, and are able to change healthcare providers without being upset.  They do not feel limited by only having certain healthcare providers to select from.

Most healthcare providers in Florida accept Medicare assignment.  This means the healthcare provider agrees to accept the payment determined by Medicare.  This does not eliminate your need to meet a deductible or pay a co-pay.  We are fortunate in Florida. In many states with plenty of private insurers and patients covered by insurance provided by employers the reimbursement to healthcare providers is more significant than the reimbursement Medicare pays. Many healthcare providers choose to not accept Medicare.

If your healthcare provider only participates with certain insurance plans it is not an indicator that they are good or bad.  You should not feel like you have poor choices if you are limited to certain healthcare providers by your Medicare Advantage Plan.  Each insurance company is allowed to negotiate contracts with whatever healthcare provider they choose.  It is often determined by costs and reimbursement rates, truly nothing to do with the patient.  In recent years we have seen many small healthcare providers join together to become much larger offices.  This allows for economies, with technology being one of the primary expenses.  The more cost effective the healthcare provider is, the better contract they can negotiate with the insurance company.

Good luck with reviewing your options and determining what plan works for you.  At the end of the day, remember you are in charge of your own health, responsible for how you take care of your body, and need to determine what works best for you.