It is that time of year again — time to reassess whether your Medicare plan is working for you. Medicare’s open enrollment period began November 15 and continues until midnight December 31. During this period, you may enroll in a Medicare Part D (prescription drug) plan or, if you currently have a plan, you may change plans. In addition, during this period you can return to traditional Medicare from a Medicare Advantage (managed care) plan, enroll in a Medicare Advantage plan, or change Medicare Advantage plans. Beneficiaries can go to www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to make changes in their Medicare prescription drug and health plan coverage.
If you take no action, you will remain in your current plan unless your Medicare Advantage or drug plan is terminating its Medicare contract. Also, if you receive the Low-Income Subsidy (LIS) to help pay for some or most of your Part D drug costs, you may be randomly reassigned to a different plan. (For more on the LIS program, also known as “Extra Help,” click here.)
But even beneficiaries who were satisfied with their plan in 2009 need to review their options for 2010. Prescription drug plans can change their premiums, deductibles, the list of drugs they cover, and their plan rules for covered drugs, exceptions and appeals. Medicare Advantage plans can change their entire benefit package and as well as their provider network.
Average premiums for prescription drug plans will rise 11 percent from $35 in 2009 to nearly $39 per month in 2010, which is a 50 percent increase from $25.93 in 2006, the first year of the Medicare Part D drug benefit. Also, more drug plans will charge a deductible in 2010. Sixty percent of plans will charge a deductible, up 15 percent from 2009. The number of plans that offer enrollees some coverage in the doughnut hole — the coverage gap when consumers pay the full price for their prescriptions — continues to shrink as well.
At www.medicare.gov/MPDPF you can evaluate drug plans. The Web site allows you to enter the list of medications you currently take to determine the amount that each prescription drug plan available in your area charges for premiums, copayments, and deductibles. It also allows you to compare Medicare prescription drug plans based on customer service and other criteria. You can compare Medicare Advantage and Original Medicare plans at www.medicare.gov/MPPF/. If you are enrolled in a Medicare Advantage plan, chances are it offers its own prescription drug coverage.
Some factors to look at when evaluating your drug plan include:
- What is the monthly premium?
- Does the plan continue to cover necessary drugs?
- Does the plan provide coverage for drugs in the “doughnut hole” or coverage gap?
- What pharmacies are covered under the plan?
Some factors to look at when comparing Medicare Advantage plans include:
- What is the monthly premium?
- What is the cost sharing for doctor visits?
- Which doctors and hospitals are covered?
- Are any extra benefits included and will they be useful to you?
The Center for Medicare Advocacy offers a detailed list of things to consider when evaluating Part D and Medicare Advantage plans. For the list, click here.
For ElderLawAnswers’ checklist, “10 Factors to Consider When Choosing a Medicare Drug Plan,” which includes a link to a Drug Plan Comparison Worksheet to help you compare drug plans side by side, click here.
For the Medicare Rights Center’s “What questions should I ask before joining a Medicare private health plan?” click here.
For the Center’s “Enrolling in Part D and Changing Drug Plans,” click here.
Medicare’s Medicare and You handbook was mailed to all Medicare beneficiaries in October. The handbook is also available online. To download an copy, click here.
The Kaiser Family Foundation has published three “Data Spotlights” on “Medicare Advantage Availability and Premiums,” “Part D Plan Availability in 2010 and Key Changes Since 2006,” and “Medicare Part D 2010: The Coverage Gap.”
For more information on Medicare, click here.
To discuss Medicare or other Elder Law matters with an attorney, please email the Elder Law Center or call 630-844-0065. The Elder Law Center is located in Aurora, IL, Kane County, in the Chicago Western Suburbs.