Medicare changed things up a bit this year by scheduling open enrollment early. Because Medicare is in the news, I’ve been getting a lot of calls from clients to ask me about Medicare. While most people understand that they can become eligible for Medicare when they turn 65, they wonder about the types of Medicare plans available, and what plan they should choose. Today, we’ll talk a little bit about the basics of Medicare, and about how to choose a Medicare Part D prescription drug plan.
Here is the basic Medicare alphabet:
Medicare Part A covers hospital insurance that can help pay for inpatient care at hospitals, skilled nursing facilities, hospice, and home health care.
Medicare Part B covers medically-necessary service such as doctor’s services, outpatient care, home health services, and some other services. You will pay a premium to be covered by Part B.
Medicare Part C is a Medicare Advantage Plan.
Medicare Part D is the prescription drug coverage.
In order to become eligible for Medicare, you must be age 65, or you must have been receiving Social Security Disability benefits for 24 months. Most people who are on Social Security or Railroad Retirement benefits will automatically get Medicare Part A and B starting on the first day they turn 65, or when they have completed the full 24 months after beginning to receive Social Security Disability. One exception is that if you have ALS – Lou Gehrig’s disease- you are eligible for Part A and B in the month your disability begins.
Every year, for those who are qualified for Medicare, there is an open enrollment time when you have the ability to sign up for a new Medicare Part C or Part D plan.
Normally, the open enrollment period begins in January. However, this year the open enrollment period began on October 15 and ends on December 7. If you want to know when to enroll in Social Security Part A and Part B, and when to enroll in Part C and Part D here is a handy chart: http://www.medicare.gov/Publications/Pubs/pdf/11219.pdf
Medicare Part D is probably the most confusing of the Medicare Alphabet Programs. Medicare Part D is the program that offers prescription drug coverage to those who are qualified for Medicare. In order to get the drug coverage, an eligible person must join a plan. The plans are run by private insurers or other private companies approved by Medicare.
Medicare Part D is available if you are otherwise-eligible for Medicare A & B. If you don’t enroll in Part D when you become eligible, you might have to pay a slight penalty when you do join at a later date. You can enroll in two basic types of plans: Medicare Prescription Plans or Medicare Advantage Plans. The Medicare Advantage Plans are usually HMO’s or PPO’s that give you all of your Part A and B coverage, and in addition may give you drug coverage. If you choose another Part D plan while already enrolled in a Medicare Advantage Plan that offers a drug plan, you may become disenrolled from your HMO or PPO plan and returned to regular Medicare.
How can you choose the right Medicare Part D plan? The plans are run by private insurance plans, or private companies, and the cost of the plan is generally based on the prescriptions you use, the “formulary” of the plan, and whether you go to a pharmacy that is within your plan’s network. The formulary is the list of drugs that a Medicare plan covers.
The Medicare.gov website is full of information about the plans that are available, and is also full of advice on how to choose a plan. To choose a plan, you can enter your zip code and your prescriptions in the formulary finder on Medicare’s website. http://plancompare.medicare.gov/pfdn/PlanFinder/DrugSearch. The plan finder will then give you a list of providers and will tell you the cost of the plan and the cost of the drugs. You can then call the providers with any questions you might have.
Erica Dumpel, with Czajkowski Dumpel & Associates, Inc. http://cdainc.net/ an experienced healthcare plan advisor, emphasizes that you should research the plans on a yearly basis. If you have a number of prescriptions, hunting down the right plan can take a lot of time – but can also save you a significant amount of money each year.
If you miss this year’s open enrollment period, or if you decide not to change plans, be sure to put a reminder on your calendar to review your plan again next year. In fact, I recommend that you schedule a yearly financial and legal checkup, which should include a thorough review of all of your insurance premiums, co-pays and prescription costs.
Will you start treating your Medicare Plan as part of your Financial Plan?