Managing Medicare

“Just Medicare” is typically referred to as “Original Medicare.” Your HMO plan is a Medicare Advantage plan. Typically, what you’re buying with a Medicare Advantage HMO plan is:

• An HMO network of providers who are contracted to provide you with service
• Prescription drug coverage
• An annual limit of no more than $6,700 on the amount of money you’ll pay out of pocket.

Most Advantage HMO plans will have these three things, but they’re not provided by Original Medicare. Original Medicare is a terrific benefit, but it has gaps. Original Medicare (Parts A and B) have deductibles. And the Part A deductible is not tied to a calendar year like they are with traditional health insurance. Instead, it’s tied to a 90-day benefit period, with some exceptions. After the 90 days, the deductible typically resets.

The Part B benefit includes coinsurance after you meet your deductible, which means Medicare pays a percentage of each bill and you pay the rest (typically between 20 and 45 percent, depending on the service) after applicable premiums and deductibles. Your Advantage plan may also have deductibles and coinsurance, but Original Medicare does not limit how much you’ll pay out of your own pocket for covered medical services each year. And, again, Original Medicare does not cover the cost of most prescription drugs. Many people who participate in Medicare without an Advantage plan elect to fill the gaps with Medicare Supplement and a Part D prescription drug plan.

If you’re trying to save money on your monthly premiums, you can go online to see prices and benefits for competing Medicare Advantage plans that may be an option for you. Each year there is an annual enrollment period when you can switch from one plan to another. This year the annual enrollment period runs from October 15 through December 7. If you do decide to go with original Medicare, you will need to enroll in a stand-alone Medicare Part D plan to be sure you have prescription drug coverage and don’t face penalties for going without. You can pick your Part D plan during the same annual enrollment period.

You may also try to get coverage through a Medicare Supplement, but most Medicare Supplement plans will require you to pass a health screen if you are not within your first six months of Medicare eligibility. So, there is a chance you will not have access to that alternative.

Details about Medicare Advantage Plans for 2012 will soon be available. Medicare reports that on average Medicare Advantage premiums will be four percent lower for 2012. That is good news, but it is still important to see what your plan will charge in premiums next year. Also, review your copayments if you require medical care, your out of pocket spending limits and your prescription drug benefit.
 

Medicare might pay for the bed rails. The doctor’s order is necessary and the equipment must be purchased from a Medicare certified supplier. You can check with Medicare in advance of the purchase by calling 1-800-MEDICARE. If you have a Medicare Advantage plan you should check with that plan to make sure you follow its requirements.  

You’re right. The donut hole resets each year. Annual enrollment for the 2012 plan year runs from October 15 through December 7, 2011, so we are approaching the right time for you to go online and check to see if there will be any changes in your mother’s existing plan as well as the whether the coverage provided by other plans better fit her situation. I would highly recommend that you use a Medicare Part D prescription drug plan comparison tool, such as the one we offer at PlanPrescriber.com or the one that is available at Medicare.gov. Here’s why: If your mother hits the donut hole in 2012 she can get a 50 percent discount on brand-name drugs and a 14 percent discount on generic drugs if the drugs she’s taking are covered by her plan.

She can only access those discounts if the drugs she takes are covered by the plan she’s enrolled in. And, if the plan she selects does not include her drugs on the plan’s formulary, she could wind up paying full price for those drugs.
 

If you are a caregiver for your parents and you’re trying to enroll them in a Medicare Part D plan when they’re not with you, make sure you have your parent(s) give you power of attorney so that you’re authorized to make that decision. When you sign your parents up, the insurance company will ask you for a copy of the power of attorney when you sign the paperwork. However, if you don’t have power of attorney, don’t let that stop you from helping your parent(s) enroll. You can work with an agent to pick the right plan, and then have your parent follow-up with the agent to confirm their decision.

If your mother is just looking to you for a second opinion on her choices, she can ask her agent to add you to a conference call when she is reviewing options with the agent. The agent should be able to make plan materials available to you by e-mail.
 

This is a great question as it is an important reminder to everyone enrolling in Medicare plans this year. Medicare’s Annual Enrollment Period (AEP) for Prescription Drug and Medicare Advantage plans did change this year. The new Annual Enrollment Period takes place between October 15 and December 7, 2011. It starts a full month earlier than last year and ends three weeks earlier as well (previously, AEP ran from November 15 – December 31).

What’s good about the date change is that it pushes the enrollment process up ahead of the holiday season, where most people probably don’t want to be pouring through insurance information. The bad news is that not everybody may be keeping track of these new dates. Every year we get phone calls on January 1st from people who forgot to call in December and want to try and make a late change to their coverage. And, unfortunately, we have to tell them that they’re too late. I’m fully anticipating the number of these calls to increase in 2011.

That being said, I do think that in the long run the date change is a good thing. In the past, Medicare’s Annual Enrollment Period encompassed Thanksgiving, Chanukah and Christmas, and ended on New Year’s Eve. These are major US holidays when people tend to travel, visit family and generally just have an awful lot going on. By moving the event up three weeks, my hope is that more people will make their changes early so that they can get it over with and enjoy the holiday season.