By Michelle Singletary
With so much fuss and frustration over the open enrollment for the health care marketplaces, some people might be missing important information about another open-enrollment season.
Open enrollment for the exchanges is overlapping and overshadowing the importance of the Medicare open-enrollment period, which started Oct. 15 and ends Dec. 7. It is during this period that those covered by Medicare can change their health plan and prescription drug coverage for 2014.
Although the Medicare open enrollment process runs smoothly, it is still a complicated system with its alphabet plans — Part A is hospital insurance, Part B is medical insurance, Part C is Medicare Advantage, (offered by private companies approved by Medicare such as an HMO), and Part D is prescription drug coverage — that require recipients to pay close attention to the rules and exceptions.
“What’s really important is if you are happy with your coverage, you don’t have to change,” said Frederic Riccardi, director of client services at the Medicare Rights Center, a nonprofit organization based in New York. “But plans can change cost and benefits every year.”
By now you should have received your “Annual Notice of Change,” which lists the changes in your plan, such as the premium and copays. It’s so important that you review the document.
The notice will compare the benefits in 2014 with those you’ve received this year. In addition to your health care choices, pay particular attention to your prescription drug plan and the list of covered medications. Insurers change the drugs they cover, their procedures, their rates and sometimes their networks of doctors and hospitals.
But don’t just focus on prices. Balance affordability with coverage, Riccardi says. Make sure the medications you need are still covered. Check to see if under your plan you need prior authorization, or there are quality limits or set therapy, which means requiring a different drug before the plan will cover the one prescribed.
Only six in 10 seniors said they (or someone on their behalf) review their plan options every year, according to a survey by the Kaiser Family Foundation. One-fourth said they rarely or never review their options.
In another study, Kaiser found that between 2006 and 2010 only 13 percent of all Medicare Part D enrollees switched plans during the annual enrollment period. Here’s the thing. Had those folks switched plans at some point between 2006 and 2010, they were likely to end up in a plan that lowered their premiums.
“Only a small fraction of enrollees, however, are enrolled in the lowest-cost Part D plan available to them, based on the specific drugs they take,” the Kaiser report said.
Here are some things you should know for the Medicare open enrollment:
•There are more high-quality plans to choose from. In fact, you may have received a letter from Medicare stating that your plan has received less than three stars (out of a scale of one to five) for three consecutive years. The letter will let you know that you can go on the Plan Finder and change to a plan with more stars. Go to www.medicare.gov and search for “Medicare Plan Finder.”
Average prescription drug and Medicare health plan premiums prices remain stable for next year. Most people don’t pay a monthly premium for Part A because they have at least 40 quarters of Medicare-covered employment. Part A pays for inpatient hospital, skilled nursing facility, and some home health care services. If you pay a premium, you’ll see a drop of $15 to $426, according to the Centers for Medicare &Medicaid Services. Beneficiaries who have between 30 and 39 quarters of coverage may buy into Part A at a reduced monthly premium rate, which is $234 for 2014, a decrease of $9. The standard Medicare Part B monthly premium, which most people pay, remains the same at $104.90 a month.
If you fall into Medicare’s prescription drug coverage gap known as the “doughnut hole,” you will get discounts of about 53 percent on covered brand-name drugs and 28 percent discounts on generics. This price break is the result of the Affordable Care Act’s provisions to close this gap.
If you’re having trouble understanding your choices or you have questions about your plan changes call 1-800-MEDICARE (800-633-4227) or go to medicare.gov.
Yes, I know, there’s a lot of information to digest.
“It’s ridiculous, right?” Riccardi says after we’ve talked a while about what consumers need to know.
Still, it is what it is, and letting the complication lull you into inertia can result in your being stuck for another year in plans that don’t meet your medical needs.
Washington Post Writers Group