Category Archives: Medicare

3 Vital Keys in Reviewing your Medicare Plan during Open Enrollment

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Here are 3 vital things you need to know when reviewing your Medicare Plan during open enrollment:

#1: Is you Primary Physician on the Plan for 2016. If you have primary care doctors or specialists you have been using, and want to keep using, make sure they will continue to be in the network of the Medicare Advantage plan where you are enrolled. The networks, which are the lists of approved doctors and hospitals by the Medicare Advantage plan, change frequently. Ask your doctors now if they have signed up to continue in the plan for 2016. If the doctors have dropped out, you could face a big financial risk. If you go outside the network of your particular plan, you may be required to pay a much larger share of the cost, and in some, cases you may have to pay the full cost without any reimbursement from the insurer.

“Will I be able to use my doctors? Are they in the plan’s network?
Do doctors and providers I want to see in the future take new patients who have this plan?
If providers aren’t in the network, will the health plan still cover my visits if I choose to see them?
Who can I choose as my Primary Care Physician (PCP)?
Does my doctor need to get approval from the plan to admit me to a hospital?
Do I need a referral from my PCP to see a specialist?”

 

#2: Which specialists, hospitals, home health agencies and skilled nursing facilities are in the plan’s network? Plans change form year to year. For example, in 2016 Blue Shield now has a contract with Community Memorial in Ventura, which is great news for residents of Ventura.

#3: Check your drugs for coverage under the plan. The list of approved drugs by Medicare Advantage plans, called a formulary, is constantly changing. Plans add and remove drugs, and change the co-payments and deductibles for these medications.

Check the preferred pharmacy list to make sure there is a drug store conveniently close to you. The drug prices depend on buying the medications at a pharmacy which has a contract with the health plan. Many plans are now using lists of preferred pharmacies, where the price will be cheapest. It can make a substantial difference, so you want to use a preferred pharmacy whenever possible. Make sure the plan has one located conveniently near you.

 

 

Medicare Open Enrollment

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Medicare open enrollment season, which runs from October 15 to December 7 this year, is a good time to review your medical plan coverage. Making the right choices can save you thousands of dollars and minimize headaches should you need expensive medical coverage during 2016.

During open enrollment season, you can make changes to your medical plan, leave your plan entirely for a different plan or keep your current plan if you’re satisfied with the coverage. Any changes you make will take effect on Jan. 1, 2016.

Traditional Medicare or Medicare Advantage?

If you choose to change your coverage during open enrollment season, a basic choice is whether to enroll in a Medicare Advantage (MA) plan or traditional Medicare. In either case, you’ll need to pay a monthly premium for  Part B coverage, which for most retirees is $104.90 in 2015. MA plans or Medigap policies cover some medical costs not covered by Medicare.

Enrolling in a traditional Medicare plan allows you to select your own doctors, provided they accept Medicare-approved amounts as full reimbursement for covered services. If you buy a Medigap policy, it will cover a portion of expenses not covered by Medicare — deductibles and copayments should you incur medical expenses from doctors who participate in Medicare.

MA plans provide basic medical services covered by Medicare, plus some costs that would normally be paid out-of-pocket if you didn’t have any supplemental coverage. MA plans generally require you to use health care facilities, doctors and other professionals in the MA plan’s existing network, although some plans may cover out-of-network expenses. The total premiums paid for Medicare and MA plans combined are often lower than the total premiums combined of the traditional Medicare plan and supplemental Medigap plans.

If you enroll in traditional Medicare, you’ll need to buy Part D coverage (coverage for prescription drug costs) separately. Most MA plans cover the cost of prescription drugs, although some may require that you buy Part D coverage separately.

One basic tradeoff is the freedom of choice you have regarding doctors and facilities under traditional Medicare plus Medigap insurance, which also comes with generally higher total monthly premiums, versus the lower total monthly premiums of an MA plan with the resulting restriction of choice regarding doctors and health care facilities.