When Rose Rush, 67, of Miami started taking new medicine for diabetes, she promptly saw her prescription costs rise. Now Rush, who is on Medicare, is evaluating plans to see if she can lower her drug costs by choosing another provider.
As Medicare’s open enrollment got underway this week, millions of Medicare beneficiaries are being urged to do the same.
“Each year plans can change what they cost and what they cover. A person’s health needs can also change from year to year,” said Isabella Leung, spokeswoman for the Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services. “People with Medicare should take advantage of open enrollment to look at how changing costs, benefits and quality could affect them.”
The annual open enrollment period, which ends Dec. 7, allows Medicare beneficiaries to move from Original Medicare (known as Parts A and B) to a Medicare Advantage Plan (Part C) or vice versa. They also can elect to change their prescription drug coverage (Part D). Changes will take effect Jan. 1.
This year, some providers have consolidated plans with identical coverage, which means about 1,400 Broward and 300 Miami-Dade residents will receive notices renewing them to a different plan within the same company.
“Plans were consolidated with the purpose of making plan choices simpler for the consumer,” said Andrea Gary, spokeswoman for the state Department of Elder Affairs. Consumers should examine the benefits of the new plan, she said, to make sure it meets their needs.
Even if you’re sticking with the same plan, it’s important to examine your coverage every year, Gary said. “It may have the same name, but it could change formularies or benefits. They can change from year to year, so it may not offer the eye benefits or gym memberships it did in prior years,” she said. “If people are not reviewing the information, you may get enrolled in a plan you don’t want.”
Rush had always favored retail pharmacies for drugs, but now she’s looking at mail-order pharmacies to lower costs. And she’s evaluating Medicare providers to see which best meets her needs.
“Medicare has great online tools where you can look at price comparisons of deductible and co-insurance, but the bottom line is annual cost. I go to that first,” she said.
The Medicare.gov website also alerts you if a generic is available for a name brand drug you are taking, so that you can discuss it with your doctor, she said. Rush, a consultant for the Alliance on Aging in Miami, and a former volunteer for SHINE, Serving Health Insurance Needs of Elders, a federally-funded, volunteer-based program, is used to advising seniors to compare options. Now she’s taking her own advice.
“People are very overwhelmed by choices during open enrollment. They get tons of mail from all these companies,” Rush said. “It’s best to compare plans side by side.”
A copy of “Medicare and You 2013,” which explains deadlines and benefits, has been mailed to every Medicare beneficiary. A digital copy at Medicare.gov can be read online or downloaded to an eReader like a Kindle or Nook.
Enrollment in Medicare Advantage Plans is projected to rise by 11 percent in the next year, according to the U.S. Department of Health and Human Services. Since the Affordable Care Act was passed in 2010, Medicare Advantage premiums have fallen by 10 percent and enrollment has risen by 28 percent.
The average monthly Medicare Advantage premium in 2013 is projected to be $32.59, a $1.47 increase over 2012. The average basic Medicare prescription drug plan premium is projected to be $30 in 2013, holding steady from last year.
Drug coverage in the Part D “donut hole,” the temporary gap in prescription coverage that begins after you and your drug plan have spent a certain amount for covered drugs, will increase until 2020, when the donut hole will be closed. Those who reach the donut hole will enjoy a little more savings in 2013 on prescription drug costs. Coverage has gone up from 50 to 52.5 percent for name brand drugs, and from 14 to 21 percent for generics.
Free help to examine Medicare options is available from SHINE volunteers, who help clients compare policies and understand health insurance coverage, said Kathy Sarmiento, a SHINE liaison with the Alliance for Aging in Miami.
There are 28 SHINE volunteers among 10 counseling sites in Miami-Dade and Monroe counties. In Broward, there are 22 volunteers at 14 sites. Counseling sites are listed at FloridaShine.org. Appointments can be made by calling 1-800-96ELDER (1-800-963-5337), or 305-670-6500, ext. 211, in Miami-Dade or 954-745-9779 in Broward.
Last year, 106,000 people in Florida used SHINE services, Gary said.
“We can’t make choices for them or even advise them, but we can say that one plan is better than the other at meeting your needs,” she said. “We can explain benefits and narrow down choices, depending on what’s important to them.”
Here’s a look at what you should review during open enrollment:
The drugs you take
Make a list of the prescription drugs you take, including brand names. Go to www.medicare.gov/find-a-plan and enter your prescriptions to find potential costs: monthly premiums, deductibles and co-payments for plans in your area, as well as national plans.
“Medicare has really been working hard on its website, to make it more user friendly,” Sarmiento said. You can enter just a ZIP Code and your drugs for the coverage information. For more specifics, enter your Medicare number.
If you have Original Medicare, you can check separate stand-alone prescription plans. Medicare Advantage Plans usually include prescription drug coverage, Sarmiento said.
This will not only help you check prices, but also tell you if a plan covers the medicine you take.
“Prescription drug costs can be a major expense in a senior’s life, so if you can change anything to reduce those costs, this is the time to look at it,” Sarmiento said.
Check to see if your plan uses step therapy, which requires patients to use generic drugs before they can get a name brand drug. This also can affect your costs, Sarmiento said.
The doctors you see
Sometimes a doctor will stop accepting a plan, or begin accepting new plans. Check to see if the doctors you like and the hospital you prefer will accept your plan in 2013.
You don’t need to talk to the doctor directly, Sarmiento said. The doctor’s office staff will know.
Think about future needs, said Regine Lemaire, the SHINE liaison in Broward. “For example, an individual might not look at a skilled nursing facility benefit, because they are agile and in good health, she said. “But what happens if you fall and you need home health or a skilled nursing facility?”
If you need financial help
Many South Florida residents qualify for Extra Help, the income-eligible program that helps pay prescription drug costs, including premiums, deductibles and co-pays, Sarmiento said. You can use this assistance if you have Original Medicare or a Medicare Advantage Plan. A SHINE volunteer can help determine if you qualify for this assistance, or you can check the Social Security Administration’s website at www.ssa.gov or call 800-772-1213.
How you want to enroll
Gary recommends using the Medicare Finder tool at Medicare.gov, or calling 1-800-Medicare to enroll in your chosen plan, rather than going through the provider.
Sometimes coding errors can happen with an individual provider that will land you in the wrong plan, she said. “It’s just for your security, to make sure you get what you wanted,” Gary said. There are no incentives offered in enrolling directly with the provider, she said.
After Oct. 15, plans can still change, so make sure your research is up to date when you go to enroll, Gary said. “If you did your research three weeks ago, make sure you have the most up-to-date information,” Gary said.
Check FloridaShine.org’s community events link for on-site enrollment dates, where counselors go with laptops and printers. Just show up with your list of drugs and your insurance cards, and you can get counseling on the spot, and walk out with a comparison of plans, Lemaire said.
“There are a lot of choices here in South Florida,” Sarmiento said. “This is an opportunity to see what else is out there.”