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Time for your Medicare checkup

 

What you should know

Deadlines

Oct. 15 to Dec 7: During open enrollment, individuals can 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).

Jan. 1 to Feb. 14: You can disenroll from a Medicare Advantage Plan and go to Original Medicare and a stand-alone Prescription Drug Plan (Part D).

5-star enrollment

Medicare rates Medicare Advantage Plans from one to five, with five being the highest. Miami-Dade currently has one 5-star plan, Leon Medical Centers Health Plans — Leon Cares HMO. Miami-Dade residents can take advantage of a special enrollment option for the highest rated plans and switch to a 5-star Medicare Advantage Plan anytime during the year. There are no 5-star plans in Broward.

Questions?

•  Medicare: www.medicare.gov/find-a-plan or call 800-MEDICARE (800-633-4227), for help in multiple languages.

•  Social Security: www.socialsecurity.gov or call 800-772-1213 to find out Medicare eligibility, how to enroll, apply for Extra Help with Medicare prescription drug costs and ask questions about premiums

•  SHINE (Serving Health Insurance Needs of Elders): www.floridashine.org, where you can email questions or ask someone to call you, or 800-96ELDER (800-963-5337)


Special to the Miami Herald

Here’s the good news about Medicare open enrollment: the new healthcare laws don’t affect how you shop for coverage, and you don’t have to go to a new health exchange site to compare plans.

“They are two separate things. If you are on Medicare, there is no reason to go on the Health Exchange, because there is nothing for you there,” said Anne Chansler of the Florida Department of Elder Affairs. The Health Exchange is for people who are under 65 and uninsured, she said.

Medicare open enrollment, which began Oct. 15 and ends Dec. 7, allows Medicare beneficiaries to review and compare coverage, and change to a new plan if they wish.

“If you were in a plan that fit you well last year, but this year you have new prescriptions, new medical needs, new doctors — that plan may not be the best fit for you anymore,” said Chansler, who is state director of SHINE, Serving Health Insurance Needs of Elders, a federally-funded, volunteer-based program to help Medicare beneficiaries understand and compare coverage. “That’s why we encourage people to look at the options available every year, because they may have something in the system that’s better or more affordable.”

During open enrollment, Medicare beneficiaries can 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.

Even if you want to stick with the same plan, it’s important to examine your coverage every year.

“You should go through the exercise and recheck costs and what your plan covers,” said Kathy Sarmiento, a Miami-Dade SHINE liaison who works out of the Alliance on Aging office in Miami. “Drug costs can change, and what a plan covers can change.”

A copy of “Medicare and You 2014,” 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. You can also call 800-MEDICARE for help.

Since the Affordable Care Act was passed in 2010, Medicare Advantage premiums have fallen by 9.8 percent, according to the Centers for Medicare & Medicaid Services. In 2014, the average Medicare Advantage monthly premium is projected to be $32.60. The Medicare prescription drug premium plan is projected to be $31 per month, holding steady since 2010. The deductible for standard Part D plans will decrease by $15 to $310.

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 2014 on generic prescription drug costs. Coverage has increased from 21 to 28 percent for generic drugs. Coverage will remain at 52.5 percent for name brand drugs.

Free help to examine Medicare options is available from SHINE volunteers, who help clients compare policies and understand health insurance coverage.

“They can also screen you to see if your income and assets qualify you for programs that will help pay your co-payments, premiums and drug costs,” Sarmiento said.

There are a lot of seniors in Miami-Dade who are 65 or older but have never worked in this country, she said. If they are U.S. residents and have lived here for at least five years, and if their income and assets meet the limits, they can apply for assistance programs for low-income residents, Sarmiento said.

There are 32 SHINE volunteers in Miami-Dade and Monroe counties, and 31 volunteers in Broward. Counseling sites are listed at FloridaShine.org. Appointments can be made by calling 800-96ELDER (963-5337). In Miami-Dade, residents also can call 305-670-6500, ext. 1156.

“Go to a SHINE counselor in your county, because the insurance is different in every county,” Sarmiento said.

Last year, 150,000 people in Florida used SHINE services, Chansler said.

Here’s a look at what to review during open enrollment:

Drugs

Start with a list of the prescription drugs you take, including the brand names. Go to www.medicare.gov/find-a-plan and enter your ZIP Code or Medicare number to find plans in your area. You can check monthly premiums, deductibles and co-payments, as well as if a plan covers the medicines you take.

If you have Original Medicare, you can check separate stand-alone prescription plans. Medicare Advantage Plans usually include prescription drug coverage, 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, or if there are quantity limits for a drug. If you have a chronic health condition, such as heart disease, you can filter your online search to find “special needs plans,” which are geared for people with chronic conditions.

Doctors

Do your research and talk to your doctors’ offices about what plans they will accept next year, said Vanessa Rico-Robie, SHINE liaison for Broward. Sometimes a doctor will stop accepting a plan, or begin accepting new plans.

“When you know what the costs are going to be, and you know what the coverage is going to be, that’s making an educated decision,” Rico-Robie said. “An educated decision is the best decision.”

Financial assistance

If you need help paying your premiums, there are programs to help people who meet certain income and asset limits, Sarmiento said.

Medicare Savings Plans help pay Original Medicare premiums, and Extra Help reduces the cost of prescription coverage, co-payments and deductibles. A SHINE volunteer can help determine if you qualify for assistance, or you can check the Social Security Administration’s website at www.ssa.gov or call 800-772-1213.

“Most people are concerned about what is going to change between 2013 and 2014,” Rico-Robie said. “For beneficiaries who are very elderly and don’t know who their insurer is, or who don’t have family (to help them), it can be very difficult for them to piece everything together, and that’s how SHINE can help.”

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