Tuesday, November 25, 2014

Medicare enrollment through Dec. 7; expert cites advantages of original Medicare

The Medicare open enrollment process, which continues through Dec. 7, can be confusing and overwhelming, according to an insurance expert who works with health care providers and consumers to try to clarify the issues.

Jim Richmond, with Managed Care Partners, explained the difference between original Medicare – which he likened to Classic Coke – and Medicare Advantage plans, which are actually managed by private insurers and replace rather than supplement Original Medicare.

Richmond said there are two basic “roads” to get to Medicare coverage – Original Medicare, with Parts A, B, and D; or Medicare Advantage plans, or Part C. “Original Medicare provides coverage directly to you,” he said, noting that it is made up of Part A and/or Part B. “Medicare Advantage plans are provided by private insurance companies and the costs, coverage and rules may be different than Original Medicare.”

He said Medicare Advantage plans “fully replace” original Medicare, though consumers sometimes confuse them with “supplemental.” He said the companies who offer these plans have contracts with Medicare to provide the coverage.

Richmond cited numerous examples of options for Medicare Advantage or Medicare supplement plans – sometimes called “Medigap” – and pointed out that an Original Medicare plan with a supplement policy is often the best choice for those who can budget the additional premiums. He used the example of regularly changing the oil filter in a car – the expense is more up front, but it can reduce costs down the road. That’s how he described the difference between Medigap policies – which can cost more in premiums up front – or a Medicare Advantage plan, which often can have lower premiums but can mean a lot more out-of-pocket expense when the consumer actually uses the plan.

Richmond also noted that the Advantage plans often have limited networks, usually by geographic areas, and encouraged participants to investigate those details before making their final decisions.

Richmond also recommended that during open enrollment each year that enrollees:

  • Check with your physicians and hospitals of choice to be sure they are in any plans you are considering – for example, Reid and Reid Physician Associates are not in network for Medicare Advantage plans.
  • Consider potential out-of-pocket expenses of each plan, noting that some plans offer no coverage or limited coverage if the care is received out of network.
  • Make sure if you need prescription drug coverage that you check each plan to see if it is provided, and if so, what drugs are in the “formulary” for coverage.
  • Remember that if you have a Medicare Advantage plan that includes prescription coverage and enroll in a stand-alone plan, the Advantage plan will automatically be terminated.
  • If you have a Medigap policy but switch to a Medicare Advantage plan instead of original Medicare, you should drop the Medigap policy because it cannot be used to pay Medicare Advantage Plan copayments, deductibles and premiums.
  • If you have a Medicare Advantage Plan, it is illegal for anyone to sell you a Medigap policy unless you are switching back to Original Medicare in open enrollment.

Richmond also noted that if people in a plan from last year take no action during open enrollment, they will stay in the plan from the previous year – except in the case of a Medicare Advantage plan if it is discontinued. “But the plan should let you know that in plenty of time,” he said.

“The most important thing to remember is to take your time and consider all your options,” Richmond said. He said independent insurance agents can be a resource.

Richmond noted these resources for residents making the decisions during open enrollment:

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