Along with the approaching holidays and a poor economy, it is also the time of year for senior citizens to sign-up and review their Medicare plans.
The Centers for Medicare and Medicaid Services' (CMS) handbook, "Medicare and You," says, stay or switch. Seniors are allotted 45 days, Nov. 15-Dec. 31, to switch their Medicare health or prescription drug coverage for 2009. With all of the holiday activities, the time seems much shorter.
Just like any other health care plan or insurance, it takes time to review the options and find the plan that is best.
"You should review your plan yearly to make sure it hasn't changed and it still fits your needs," Frank Fowler, pharmacist and owner of Horseshoe Health and Medicine said. "This year, particularly, because many things have changed."
As a pharmacist, Fowler is not allowed to sign individuals up for Medicare due to regulations. He says it is recommended by CMS that pharmacists and physicians refer customers to someone they trust, to assist their customer with their Medicare needs.
There are many options when looking at medicare plans and the choices can be overwhelming.
To break it down, first there is the traditional free-for-service Medicare program.
With this program a person can generally get care from any doctor or hospital and receive coverage for care anywhere in the country. However, traditional Medicare has high cost-sharing requirements and does not currently cover costs of certain services. This is where supplemental coverage comes into play.
Supplemental coverage is exactly as it sounds. It covers what Medicare free-for-service does not. Some may be able to get supplemental insurance from a former employer or union. If not, supplemental insurance is available from an insurance company.
With supplemental coverage, Medicare will typically pay healthcare bills first and supplemental second. With supplemental coverage, when a person visits the doctor, they submit both their Medicare card and their supplemental insurance card.
Next is Medicare Advantage. Advantage is a health maintenance organization (HMO). Medicare HMOs cover the same doctor and hospital services as the original Medicare program, but out-of-pocket costs for these services are usually different. Medicare Advantage plans may offer more benefits than traditional Medicare, but may limit the ability to get care from the doctor or hospital of choice.
Robert Driesel who is an agent with Diamond D Group Insurance Agency of Cherokee Village, said it is very important for customers to think about tomorrow when they are signing up for a Medicare plan. Many plans, according to Driesel, will only cover the needs a customer has when they sign up, but if for some reason their health care needs change, their plan may not cover the new needs.
Agents are not allowed to ask customers for their health history or family health history. According to regulation, the only thing an agent can ask a customer for is their current medication list.
Driesel recommends offering this information to an agent so the agent can better assist the present and future needs of their customer. Driesel also recommends anyone looking for Medicare options talk with their doctor or pharmacist to see what future medication they may need before signing up for a plan.
Driesel said it is very important for a person to read and understand their handbook. He said to pay attention to what happens if a customer chooses to go to Advantage and how they can switch to supplemental if they need to.
Area Agency on Aging, a licensed agent, pharmacist and physicians can all be good places for seniors to refer questions.
When choosing a plan make sure the pharmacist and doctor accepts the plan. "You don't want to sign up with a plan your doctor is not going to take," Driesel said. "Take a good hard look, companies change their plans every year."
Another thing that many are misled by when it comes to extra help in paying for Medicare prescription drug coverage (Part D), is the yearly income and assets requirements.
The CMS handbook states, "You may qualify for extra help if your income is less than $15,600 (single) or $21,000 (married) and your resources are less than $11,900 (single) and $23,970 (married)."
The CMS handbook says these resources do not include home, car, burial plot and up to $1,500 for burial expenses (per person), furniture or other household items.
Many reports state that Medicare costs have gone up considerably but several of the reports are stating nation-wide statistics. Arkansas' Medicare plans range from $13-$108 per month. The rates have gone up since 2006, but no more than normal yearly inflation.
"Don't look at price alone," Driesel said. "Ask about deductibles and co-pays." Driesel said Medicare plans can only be switched once a year so it is important to get the plan that fits your needs.