Note: This post originally appeared at AlexisAbramson.com. If you’re interested in providing articles for SeniorHousingMove.com, please see our submission guidelines.
Alexis Abramson, PhD
Lately I’ve spoken with SO many people who are extremely confused about their Medicare benefits – especially Part D (prescriptions)! So I thought I would try to provide some information to help you manage your way through the Medicare maze…..
Close to 50 million Americans are enrolled in Medicare, and that number will continue to increase as more baby boomers turn 65. Healthcare needs and financial situations may change from year to year and now is the time to make sure your coverage is adequate. Navigating the offerings and coverage rules to find the right plan can be hard, but there are many resources at the federal and local level to help make the right choice.
Medicare’s Open Enrollment Period is when people who are currently enrolled in Medicare can make certain changes to their plan benefits. The Open Enrollment Period started on Oct. 15 and runs through Dec. 7. Changes that are made during this period become effective Jan. 1, 2013.
Below is a list of changes that can be made during the Open Enrollment Period:
- Switch from Medicare Parts A and B to a Medicare Advantage Plan (Part C)
- Switch from a Medicare Advantage plan back to Medicare Part A and B
- Switch from one Medicare Advantage Plan to another Medicare Advantage plan
- Make changes in your Medicare Prescription drug plan – Part D (i.e. start a drug plan, drop coverage or move from one drug plan to another)
What are some of the new Medicare services being offered in 2013?
The new preventive services available next year include:
- Alcohol misuse counseling
- Cardiovascular disease counseling
- Depression screening
- Obesity screening and counseling
- Sexually transmitted infections screening and counseling
Another important area for change in 2013 is that if you reach the ‘donut hole’ in your Medicare Part D prescription drug plan, you only have to pay 47.5% for covered brand-name drugs and 79% of the costs for generic drugs until you reach the end of the coverage gap.
With so many options based on where you live and what prescriptions you need, selecting a Medicare Part D Plan can be complicated and time consuming. However, every American 65 and older who wishes to enroll must sign up for a 2013 plan no later than Dec. 7, 2012.
Below are five simple tips to guide you through the process of registering for a Medicare Part D Plan for yourself – or a loved one.
1. Sign up for Medicare Part D – no matter what.
Even if you currently don’t take any prescription medications, you should still consider signing up for a Medicare Part D Plan. If you enroll late or when you are in need of drug coverage, you could face a penalty and be forced to pay much higher premiums. The only exceptions to this rule are seniors with equivalent or creditable drug coverage from an employer’s health care plan, a retiree health plan or from the U.S. Department of Veterans Affairs.
2. You can get Part D two ways, but PDPs are a more affordable option.
Your first option is to buy Part D coverage as part of a private Prescription Drug Plan (PDP) that is based on the drugs you take. Your second option is to sign up for Medicare Advantage, a Medicare HMO (Health Maintenance Organization) that also includes Medicare Part A and Part B (hospital and medical). According to the Kaiser Family Foundation, a majority of Medicare Part D enrollees opt for private PDPs.
3. Plans change annually, so take your time to research.
Assessing all your options isn’t easy. You must weigh short-term savings in monthly premiums against long-term costs from co-payments or limited overall benefits. Consider your developing health concerns and how easily a plan will allow you access to your favorite doctor or specialist and medications you may be taking.
4. Preferred pharmacies matter.
Once you’ve found a plan that fits your budget and medication needs, don’t forget about convenience when filling your prescriptions. A pharmacy accepted as “preferred” by a Medicare Part D Plan is a network pharmacy that offers covered drugs to plan members at lower out-of-pocket costs than what the member would pay at a non-preferred network pharmacy. For example, Walmart is a preferred pharmacy on multiple plans including the Humana Walmart-Preferred Rx Plan. (Incidentally, people who have high blood pressure or who are concerned about heart health should also know that Humana and Walmart just announced that members of the Humana Walmart-Preferred Rx Plan will have access to 10 hypertension drugs for a penny each when filled at one of the 4,400 Walmart or Sam’s Club pharmacy locations).
5. Medicare plan finders are your friend.
There are so many options out there, so it can be hard to keep them all straight. Try one of the simple online search tools that source the most cost-effective plan for you. You can consult the medicare.gov website for great information and resources at your fingertips. Walmart.com/RxPlan is also easy to use and compares all available plans for you based on your zip code and the medications you take.
ALEXIS ABRAMSON, Ph.D. is cited as America’s leading, impassioned champion for the dignity and independence of those over 50. Abramson is the author of two
highly acclaimed books — The Caregivers
Survival Handbook and Home Safety for Seniors. For more information go to www.alexisabramson.com.