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Key Medicare Changes: How to Choose the Right Medicare Plan for You

By Herman Weil
Senior Vice President, National Medicare, Kaiser Permanente

Medicare Basics

Original Medicare is offered to most Americans over 65 and those who are disabled, and provides coverage for Parts A and B. Generally you pay a deductible and coinsurance. You may purchase a stand-alone Part D prescription drug plan. Many beneficiaries also purchase a Medicare supplemental insurance policy to fill gaps in Original Medicare.

A Medicare Advantage plan (like an HMO or PPO) is a health plan run by private insurance companies with Medicare contracts. These plans are often called “Part C” and combine Parts A, B and usually Part D. With such a plan, you don’t need (and can’t buy) a supplemental policy. You may pay a monthly premium and copayments for covered services.

Medicare A, B, Cs (and D)
Part A is for hospital insurance, Part B is for medical insurance, usually doctor office services. Part D is Medicare prescription drug coverage, which is either offered through a Medicare Advantage plan or purchased as a “stand alone” Prescription Drug Plan to accompany Original Medicare coverage.

For more information about your options go to: http://www.Medicare.Gov and download the “2011 Medicare & You” handbook or visit http://www.KP.org/Medicare to learn more.
If you are enrolled in Medicare, now is a good time to review your health and prescription drug coverage—open enrollment for joining or switching Medicare health and drug plans runs through December 31.

Reviewing your options now is important, due to changes in the Medicare program as a result of recent federal health care reform legislation.

For 2011, you may switch Medicare Advantage health or prescription drug plans only once between November 15 and December 31, 2010. Your new coverage then begins on January 1, 2011. After this enrollment period, the only change you can make for 2011 is to move from Medicare Advantage to Original Medicare, and only from January 1 to February 15, 2011.

When you think about it, making the right choice of a Medicare plan offers a pretty big payoff…and that’s a longer, healthier, and less stressful life. To help you make your Medicare choice, the following are some considerations.

1. Recognize your particular health care needs.
Think about your changing health care needs and how those needs may or may not be covered by a particular plan. If you’re managing a chronic condition, such as diabetes or heart disease, make sure that your 2011 coverage will keep pace with your needs in coping with those conditions. Will multiple visits to a primary care physician or specialist be covered? How about classes, support groups, or the ability to see alternative practitioners to help manage the condition?

2. Consider what you want from your physician and providers.
Once you’ve assessed your particular health care needs for the coming year, evaluate a plan’s care delivery service and network of providers, and how they might work with your lifestyle and specific needs. Do you like the idea of having a large network of physicians, specialists and hospitals? Would having all your appointments, including lab work and x-rays, in one physical location be attractive to you? Do you prefer a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO)? There are benefits to both types of plans. Make sure you know the differences and how they can affect your access to care.

3. Review your past health care experiences to determine whether your needs were met.
Next, determine whether or not your past health care experiences will meet your future needs. Did anything change in 2010 and what changes would you like to make for 2011? For example, you may be ready to set some new health goals such as losing weight or better managing your cholesterol. Does a plan provide classes or online tools help you meet those new goals?

4. Determine which online support tools are important to you.
Speaking of online tools, you should also determine what a health plan offers in terms of internet-based support and resources. Having the ability to access health information, contact your doctor, and obtain test results from your own home can be invaluable, particularly if you or a loved one develop a health condition that affects mobility.

5. Ask for help in understanding anything that is unclear
Seek assistance and ask questions about anything you don’t understand. There are changes in Medicare every year. Fortunately, there are many resources, including the government’s website, www.Medicare.gov, which allow you to enroll online. Kaiser Permanente also provides a comprehensive website, www.kp.org/medicare, where visitors can learn about Medicare, explore health plans and enroll online in a Kaiser Permanente plan.

6. Examine all costs in maintaining your health when evaluating a plan’s total value.
Consider all of your health care costs and services before selecting a plan. It may be tempting to sign up for the plan with the lowest premium, but look at the total value of what you will receive in terms of service and costs. How much did you spend on your health care costs last year including premiums, deductibles and co-pays? Then, examine your options for the coming year. Does the plan offer classes, seminars or online resources? How accessible are your physicians? What is the deductible and out-of-pocket maximum for each plan?

Once you have the answers to these questions, you’ll be in a better position to evaluate the wealth of plans available to you.