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Medicare Open Enrollment: Time To Evaluate The “Health” Of Your Current Plan

By Julie Davis

The open enrollment period for Medicare started on October 15 and it runs through December 7. That means now is the time you can make changes to your Medicare plans—review what your real, out-of-pocket costs are on your current plan, look over other options and make a switch if it's in your best interest.

Keep in mind that all the talk about getting insurance under the individual mandate of the Affordable Care Act does not apply to people on Medicare, but rather to the uninsured. I you're already on Medicare, you don't have to do anything. Your Medicare isn't affected by the changes, except that as part of the reform, you should more preventive services to keep you healthy and see the donut hole in prescription drug coverage close more and more each year. However, the Medicare Open Enrollment period does apply to you—it's your once-a-year chance to review your coverage.

Why It's Important To Review Your Plan
Whether you have traditional Medicare or a Medicare Advantage plan, use the Open Enrollment period to figure out if you have the best available coverage for your unique health needs. “Your health and prescription drug needs may change from year to year or the plan you have may make changes,” says Nicole Duritz, AARP Vice President, Health Education and Outreach. “That’s why regardless of whether you have original Medicare or a Medicare Advantage plan, it’s important to evaluate your choices during open enrollment.”

When reviewing available plans, AARP recommends considering each of these factors:

  • Cost: Evaluate not only your monthly premium, but also the annual deductible and co-pays and co-insurance that you're currently paying and what you'd have to pay on other plans.
  • Coverage: Are your doctors and pharmacy and typical services you need in any new plans you're evaluating and does the formulary cover the prescription drugs you need?
  • Convenience: If you're thinking of switching, are the covered doctors, pharmacies and services easy to get to?
  • Quality rating: Many people still don't know that most plans now have quality ratings. Be sure to check out the ratings of Medicare Advantage and Medicare Part D prescription drug plans you're considering.

More information on the Medicare Open Enrollment is available online through the Medicare Plan Finder at www.medicare.gov/find-a-plan or by calling Medicare at 1-800 - 633-4227. “We know there are scammers out there,” says Duritz. “So we’re spreading the word to make sure Medicare beneficiaries know where to get accurate information.”
Cutting Prescription Costs In The Coverage Gap

Because of the donut hole, you might find that the cost of drugs to keep you healthy eats up too much of your money. Medicare suggests these 6 steps you can take to lower your costs while the donut hole is still closing:

  • Consider making the switch to generics or other lower-cost drugs. Talk to your doctor to find out if there are generic or less-expensive brand-name drugs that would work just as well as the ones you're taking now. You might also be able to save money by using mail-order pharmacies. Find health & drug plans.
  • Choose a plan that offers additional coverage during the gap. There are plans that offer additional coverage during the coverage gap (Medicare prescription drug coverage), like for generic drugs. However, these plans may charge a higher monthly premium. Check with the drug plan first to see if your drugs would be covered during the gap. Find health & drug plans.
  • Pharmaceutical Assistance Programs. Some drug companies offer help for people enrolled in Medicare Part D. Find out whether there’s a Pharmaceutical Assistance Program for the drugs you take.
  • State Pharmaceutical Assistance Programs. Many states and the US Virgin Islands offer help paying drug plan premiums and/or other drug costs. Find out if your state has a State Pharmaceutical Assistance Program.
  • Apply for Extra Help: Medicare and Social Security have a program for people with limited income and resources to help you pay for prescription drugs. If you qualify, you could pay between $1-$6 for each drug.
  • Explore national and community-based charitable programs. National and local charitable groups like the National Patient Advocate Foundation or the National Organization for Rare Disorders may have programs that can help with your drug costs. Find out about programs in your area on the Benefits Checkup website.