Health Insurance Navigator

By Lisa Zamosky

Yesterday marked the start of the Medicare Annual Enrollment period, which runs between October 15^th and December 7^th. This period is an opportunity for people with Medicare to re-evaluate the coverage they currently have and make changes, if desired.

The changes you are allowed to make during annual open enrollment are:

• Enroll in a Part D drug plan to help pay for prescription drugs
• Change an existing Part D plan to a new one
• Return to traditional Medicare from a Medicare Advantage plan
• Enroll in a Medicare Advantage plan for the first time
• Change from one Medicare Advantage plan to another

Here are 6 steps you need to take now that the Medicare Annual Enrollment period is underway.

1) Shop, shop, shop

So, you’ve been happy with your Medicare Advantage, and/or Part D drug plan. Great! So, why rock the boat?

Here’s why: As I discussed in this post last week, for 2013, the average Part D plan premium is expected to rise by about 6%. But seven of the current top 10 drug plans will see double-digit increases in premiums next year. And, Medicare Advantage plan premiums are expected to rise by about 5%.

In addition to premium costs, a plan’s benefits can also change from one year to the next, another reason why you need to examine your options and avoid operating under the assumption that the plan you currently have is the best one available to you.

A recent investigation by the University of Pittsburgh Graduate School of Public Health researchers found, for example, that only a little more than 5% of Medicare beneficiaries choose the least expensive Part D plan, costing them an additional $368 per year. Other studies have suggested that people are leaving even higher amounts of money on the table each year.

2) Take Action…Now!

Sure, you’ve got until early December 7^th to think about making changes to your Medicare coverage and it’s only in mid-October.  What’s the rush? It may seem that you’ve got all the time in the world to figure this out, but don’t delay.

PlanPrescriber is an online provider of free Medicare education and plan comparison tools. According to the organization’s CEO and president, Ross Blair, last year more than 40% of people that contacted his organization looking for help waited until the last week of the enrollment period. This is an important decision for both your health and your finances. Don’t do this under pressure and at a time when the experts available to help you are swamped with other calls. “My general advice is to start early and don’t procrastinate,” Blair says.

3) Understand ALL of Your Costs

It’s common to view a plan’s premium, or monthly cost, as the primary figure to determine its affordability. However, premium is but one factor in understanding just how much you could pay for medical care during the course of a year. You need to dig deeper and add up the following costs to gain a full picture:

• Premiums (Note: If you’re a high earner, your benefit costs will go up in 2013. Rates aren’t yet available, however).
• Co-pays
• Coinsurance
• Deductibles
• Maximum out-of-pocket costs (this is the point at which your insurer takes on the full cost of your care. This year, the maximum out-of-pocket allowed for Medicare Advantage plans is $6,700)

4) Ask the Question: Are you In or Out?

Whether your doctor, hospital or pharmacy is in or out of your insurer’s network can have a huge impact on your total out-of-pocket costs. Make sure they participate with the plan you’re in. And don’t make the mistake of assuming that because your doctor or pharmacy participated with your plan last year they will again this year. Networks regularly change.

5) Avoid Medication Mishaps

To avoid sticker shock, you must check each year that the medications you take are included on your plan’s formulary, or list of covered medications.

Another way to save: Go generic. A number of medications will be losing their patents in 2013, including three big ones: Singulair, Simbalta, and Niaspan. Ask your doctor if the generic form of your medication is available.

And Blair says he encourages people to use mail-order services. Many of the Part D plans available next year offer zero co-pay for a 90-day supply of medications if ordered through the mail.

Finally, you’ll save money by learning whether your Part D plan puts quantity limits in place or requires you to get prior authorization for a medication, among other possible restrictions, and then playing by your plan’s rules.

6) Talk to the Experts

Choosing the right plan is both incredibly important and, often, incredibly confusing. Don’t go it alone. Here are some resources for getting free, personalized advice on which Medicare plan is right for you:

Look for your local State Health Insurance Assistance Programs by visiting the Medicare.gov Medicare Helpful Contacts page or by calling 1-800-MEDICARE (1-800-633-4227).
Go online to compare Medicare Advantage and prescription-drug plans by using the Plan Finder tool at Medicare.gov. You can also compare and purchase plans at PlanPrescriber.com or call to speak with an expert at: 888-312-5447.
And for a fuller list of Medicare resources, check out my previous post on the topic here.