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Medicare primer

Knowledge is power

Annual open enrollment period set to begin Oct. 15

Monday, October 8, 2012
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— During the upcoming seven-week Medicare open enrollment period, Christine Lorence will meet with Medicare participants throughout the day to discuss whether it would make sense to change plans in 2013.

She helps seniors compare costs, assess whether their current plan will continue to cover the medical services they need, and reviews their prescription drug coverage to make sure it will still be a good fit.

“We choose a plan that will meet their needs,” Lorence said.

Lorence runs the Health Insurance Information Counseling and Assistance Program in Schoharie County. Every county in New York has such a program, funded by the state Office for the Aging, to provide free counseling about Medicare, Medicaid and other health insurance options and issues to residents.

This year’s open enrollment will run from Oct. 15 to Dec. 7. After that window closes, beneficiaries will be unable to make changes to their plan until next year.

“People have one chance every year to make adjustments,” said Christopher Widelo, associate state director for AARP New York. “Otherwise, they are not able to make changes to their plan.”

Medicare is available for people age 65 or older, younger people with disabilities and people with permanent kidney failure requiring dialysis or transplant. People enrolling in Medicare for the first time can enroll as soon as they turn 65 — they do not have to wait for the open enrollment period.

Part A, Part B

Medicare has two parts: Part A, which covers hospital care, and Part B, which covers outpatient services. Beneficiaries can choose to receive their Part A and B coverage from the traditional fee-for-service Medicare, or through a network plan called Medicare Advantage, where the federal government pays for private insurance. They can also enroll in a Medicare Part D plan, which covers outpatient prescription drugs through private insurance plans, and Medigap plans, which provide supplemental coverage for services not covered by Medicare.

More than 13 million Medicare beneficiaries, or about 27 percent of the Medicare population, are enrolled in Medicare Advantage; enrollment has more than doubled since 2005, according to a report from the Kaiser Family Foundation. Nearly 75 percent of beneficiaries are enrolled in traditional Medicare.

Experts say it’s important for people to research the various Medicare plans that are available and select one that’s right for them.

“We advise everyone to make sure they’re getting enough information,” Widelo said.

The open enrollment period allows people to switch from traditional fee-for-service Medicare to a Medicare Advantage plan, or select a different Medicare Advantage plan. Beneficiaries can also switch to a different Medicare Part D plan.

Health insurance companies have already started marketing their Medicare Advantage plans, and sales will officially begin Oct. 15.

“People are going to get a lot of information sent to them,” said Robert Hinckley, senior vice president for government and external relations at CDPHP, a health insurance provider based in the Capital Region. “There are a lot of choices and a lot of competition in this market.” He said beneficiaries will likely receive information about health care plans that they’re unfamiliar with, and that they should make sure they research their options.

Hinckley said seniors should look for value, but also quality. He said he believes that CDPHP can offer people both affordability and good service.

Shop around

“This is the once-a-year chance for people to shop around,” said Jeff Collins, director of marketing for Fidelis Care, which provides free or low-cost health insurance through the state’s Child Health Plus, Family Health Plus and Medicaid Managed Care programs. “Even when people have a plan that’s worked great for them, they should make sure it will still meet all their medical needs.”

Fidelis Care offers three Medicare Advantage and two Dual Advantage plans, which are available to people who qualify for both Medicare and Medicaid, and the company has some changes in store for 2013. For example, Fidelis’ Medicare Advantage Flex Plan will offer a new $20 per month prepaid card that people can use to purchase health-related non-prescription items at local drug stores; last year’s Flex Plan did not offer this benefit.

Also new this year is Medicare Advantage Zero Premium, which does not require beneficiaries to pay a monthly premium. Fidelis’ Medicare Advantage Without RX plan also waives monthly premiums but differs in the level of drug coverage it offers.

“We’ve tried to focus on reducing member costs,” Collins said.

New York’s supplemental drug program for seniors, the Elderly Pharmaceutical Insurance Coverage program, is also changing, as many of the benefits that were eliminated for 2012 have been restored for 2013. The maximum co-payment for EPIC recipients will be $20, just as it was before the cuts went into the effect; currently, seniors enrolled in EPIC pay 25 percent of the cost of a drug until they reach the gap in Medicare Part D coverage known as the doughnut hole.

“A lot of seniors will benefit from this,” said Lorence, noting that the Schoharie County Office for the Aging will discuss the changes to EPIC at a public seminar Oct. 30.

EPIC is open to New Yorkers ages 65 and older and provides free coverage to seniors with annual incomes below $35,000 if single or $50,000 if married.

In 2013, Medicare will undergo some changes as a result of the federal health reform bill. Yearly physical exams and certain preventive screenings, such as for depression or cancer, are now fully covered by Medicare.

“We want to make sure people understand the changes,” Widelo said.

During open enrollment, questions from beneficiaries run the gamut, Lorence said.

“Everything comes up,” she said.

People seeking information about Medicare can visit http://medicare.gov.

 
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