Medicare open enrollment is coming: What beneficiaries should know

About Bob Rosenblatt

Bob Rosenblatt has been a journalist in Washington, D.C., for more than 30 years, with much of his career focused on aging. At the Los Angeles Times, he started the paper’s first beat on aging and launched a popular advice column on Medicare and health insurance.

Photo 401(K) 2012 via Flickr

Photo 401(K) 2012 via Flickr

Medicare season is here, and consumers – your readers, viewers and listeners – need lots of help in making their choices.

Open enrollment begins Oct. 15 for the 49 million Americans on Medicare, and ends Dec. 7. This is the time when they can change the way they receive their health benefits, for coverage starting Jan. 1, 2015.

The choices are:

  1. Traditional Medicare, in which patients can get care from any doctor or hospital participating in the Medicare program. Beneficiaries pay for Part B, which covers doctors’ care, and Part D, which covers prescription drugs. Most people with this coverage also choose Medi-gap, a supplemental coverage which fills in some of the extra costs you may have. HHS just announced the Part B premiums for 2015.
  2. Medicare Advantage Plan, also known as a Part C plan. This is one-stop shopping, in which consumers pay a fee and get care, staying within a network of doctors and hospitals operated by the plan. In return for using the network, they may get some extra benefits, such as drugs, eyeglasses, and perhaps even a gym membership.

Let’s start with Medicare Advantage.

In picking a Medicare Advantage plan, consumers should be reminded to not depend on the price alone. They should make sure the plan includes the doctors they use and the hospitals in their area. Patients need to ask their doctors which plans they use. Stories can be localized with ZIP codes. Find plans in your area.

Use the general search function. When you find plans for your area, focus on the total annual cost, not just the monthly premium.

In traditional Medicare, you will be looking for two programs — one for drugs and one for supplemental coverage.

For Part D (prescription drugs), use the government’s plan finder and the ZIP code.

Consumers must enter all the drugs they take, along with and the dosages, and frequency, to get a list of plan comparisons. This is vital because plans change each year with the drugs they offer, and the prices they charge. Tip: The drug prices will be cheapest at the plan’s preferred pharmacies. Consumers should check the list and see which ones are most convenient to home.

Medi-gap is the plan covering extra charges. Find and compare plans.

There are categories of plans. The post popular is F, because it covers the 20 percent co-payment you may face from an extended hospitalization. If you have a $100,000 bill, 20 percent is a hefty $20,000. An F plan protects you. Under federal law, benefits are standard for the various categories of plans. A plan F, for example, will offer the identical benefits whether is sold in the Bronx, New York, or Talladega, Ala., or Fresno, Calif. No reason to pay a higher price anywhere if all plans are identical.

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