5 Critical Actions Medicare Beneficiaries Must Take This Year!

For 2011, Medicare beneficiaries are seeing some of the biggest changes to the program in years, including:
* amendments to Medicare Advantage plans,
* new supplemental policies, and
* benefit changes in drug coverage.

Medicare open enrollment begins on Nov. 15, 2010.  I am providing a post guest blogger by Ross Blair from PlanPrescriber.

Five “Must Do” actions for current Medicare enrollees, newly-eligible Baby Boomers and people who help older beneficiaries choose plans.

1. Pay Attention to the Drug Limitations in Your Plan: Medicare plans offering prescription drug coverage may place limits on how an individual medication is covered. Because these limits are typically set for individual medications, it’s vital not to assume that your drug is covered. Some drugs may only be covered with prior authorization from the health plan representative, step therapy (requiring that your physician must try other less expensive alternative meds first), or in certain doses and quantities (i.e. while 10 milligrams of Lipitor per month is covered, your 100 milligram prescription is not). For more information about drug limitations you can visit a site like PlanPrescriber.

2. Get to know the “Donut Hole”:  Affecting over 3 million Medicare beneficiaries each year, the “Donut Hole” occurs when enrollees reach $2,830 in drug costs and must pay 100 percent of their medication costs until their out-of-pocket Rx expenses hit $4,550. These guidelines are for 2010; with health reform, this coverage gap will begin to close every year until it is closed entirely by 2020. Some good news for this year, though: in 2010, under reform, if you reach the Donut Hole, you will receive a one-time $250 rebate check if you are not already receiving Medicare Extra Help. These checks began being mailed to beneficiaries in mid-June 2010.

To help you with the Donut Hole:

·        Consider plans offering gap coverage.

·        See if your medications have generic alternatives.

·        Use mail-order for discounted medications.

·        Check out new changes to the donut hole in 2011 at Medicare in their publication “Closing the Prescription Drug Coverage Gap”

·        Use helpful online tools like the ones available at PlanPrescriber also more discussion on the donut hole issue.

3. Check the Formulary Changes to Your Prescription Drug Plan to Ensure Your Medications Are Still Covered: It is very important to check your Medicare Part D Prescription Drug Plan each year because insurers may change what medications are covered and which drugs are not.  When enrolling in a Part D plan for the first time, check to make sure the policy covers your medications. In addition, current enrollees should review the new Part D plans because many are available with lower cost sharing, premiums and/or deductibles. Use a Medicare Prescription Drug Plan comparison tool like the one available at PlanPrescriber.com to compare premiums, deductibles, drug coverage, and estimated annual costs. You may be able save hundreds of dollars by switching your drug coverage.

4. Consider whether you will require a Medicare Supplement, or Medigap, Plan in early 2011 to balance out your needs. Medigap has its own open enrollment period, beginning the day you turn 65 and lasting six months. Prior to enrollment, decide how much coverage you need and understand how the premium is calculated. To help you, here are a couple tips:

* Evaluate your current health status and your potential health needs in the future, especially if budget is a concern. If you are looking for a more comprehensive plan with lower co-pays and lower coinsurance, it may be more expensive. A plan with basic benefits may give you the coverage and the peace of mind that you need at a lower premium.
* Each insurer decides how to set the premium for its Medigap policies by community rating, issue-age rating or age-attained rating. How the premium is set will affect how much you pay now and in the future.

5. Don’t Get Caught Paying a Medicare Enrollment Period Penalty – It is important to note when you must sign up for Medicare Parts A, B, and D. In some cases, if you do not sign up within the proper time period, you may have to pay a penalty. To avoid paying penalties, take the following steps:

·       For Medicare Part A (Hospital), contact Social Security three months before you turn 65, and if you need to sign up for Part A, do so when you first become eligible during the Initial Enrollment Period.

·       For Medicare Part B (Medical), don’t forget to sign up during the Initial Enrollment Period.

·       For Medicare Part D (Drug), join a Medicare Part D plan when you first become eligible, and do not go more than 63 days in a row without a Medicare drug plan or other creditable coverage.

Hope this is helpful. Please share your thoughts and questions