It’s Medicare open enrollment time. I thought I’d add this note to all the information out there. Do review your plan. In these days of “managed care” and “Medicare Advantage” coverage can change year to year. It’s not the old days when your health insurance coverage did not change. Medicare It is always good advice to review your current health plan with available options. I can understand that many folk consider this a needless annoyance, but it’s the way things are.
Review your basic Medicare plan and your Medicare D, prescription coverage. companies do change their plans based on their cost experience and your costs could go up dramatically. It is prudent to check and if changes would increase your costs then, shop around.
Two Situations: 1. Your health has stayed the same, but you find you are making significant payments every month on co-pays and deductibles. 2. You have had serious health problems in the past year.
1. Your health status has not significantly changed.
a) Traditional Medicare:
If you have standard Medicare with a Medigap plan, you may expect your coverage has not and will not change.
b) Medicare Advantage:
Review your healthcare outlays for the past year. Review your plan to see if those have gone up. Check against comparable plans. You may expect to find no reason to change.
Check to make sure that your doctors are still in your plan.
c) Medicare D – Prescriptions
Make a list of the prescriptions and dosages you take. Review the plan “formulary” against the prescriptions and dosages that you are taking. Review against other plans. We have found that in some plans, some dosages of the same medication are off the plan. For example a 10 mg version of a medication may be in your plan, but the 5 mg may not. If your doctor prescribes the 5 mg version, you may ask can you get the 10 mg and cut it in half? If not you may find a plan that does include the 5 mg version.
2. Your health has significantly changed for the worse.
As a general rule Medicare Advantage plans favor the healthy retire and traditional Medicare favors the ill. While the monthly insurance premium for traditional Medicare may be more, a person may receive substantial savings in lower co-pays and deductibles.
There is also the problem of the “network.” Traditional Medicare has no “network” but most Medicare Advantage plans do. For example you may not be satisfied with the patient’s doctor and want to change to one about whom you’ve heard good reports. If that doctor is not in your network you will have much higher co-pays.
In the long term care setting some families have found that a preferred nursing home is not in the network and the closest network nursing home is miles away.
Here’s a little known tip, if you are in skilled care you have open enrollment.
Special Enrollment Period: “Long Term Care”
If you are currently in a long term care setting, hospital or nursing home, you can change your Medicare plan and after you leave you have two months to change your plan again. As CMS says:
“Your chance to join, switch, or drop coverage lasts as long as you live in the institution and for 2 full months after the month you move out of the institution.”
That means if you are in a hospital and you are going to a “skilled nursing facility” (nursing home) for rehab you are in a “special enrollment period.” If your Medicare Advantage plan does not include a nursing home in your community you can switch to traditional Medicare, finish your rehab, go home and change back (if you wish) to your Medicare Advantage plan.
