On Medicare

Now is the time for an annual Medicare check-up

This is the time of year when everyone on Medicare can reevaluate features of their contracts to see if they're getting the best coverage at the best price

Sep 9, 2016 @ 5:25 pm

By Katy Votava

Just like it's a good idea to have an annual check-up for your health, it's smart to have a Medicare check-up to make sure the coverage will work when folks need it, and not break the bank. The best time of year for everyone in Medicare to have that check-up is in the fall during the Medicare Annual Enrollment Period, which is fast approaching.

The Annual Enrollment Period cycle starts Saturday, Oct. 15 and ends Wednesday, Dec. 7. Coverage goes into effect Jan. 1. This is the time of year when everyone on Medicare can reevaluate features of their contracts to see if they're getting the best coverage at the best price for their Medicare Part C and D plans.

Ninety to 95% of beneficiaries overspend on Medicare. Those are startling statistics. The most common reason beneficiaries overspend is they purchase Medicare Part C (Advantage) and Part D (prescription drug) plans that do not meet their individual health care needs. People tend to buy based on premium and overlook the benefits they use. Couples often purchase the same plan when they would be better off with different plans. Individuals may not realize what the full cost to them is until the new plan year has started and then it is too late to make a change.

All plans announce new pricing and benefits every fall. Cost increases are more likely to be hidden in other out-of-pocket costs, such as increasing deductibles, medications being placed in higher more expensive drug tiers and greater use of co-insurance as opposed to co-payments.

It's particularly important for your clients to perform their annual Medicare check-up if any of the following have happened this past year:

• Prescription medications have changed

• Major health conditions have been diagnosed

• Medicare premiums and out-of-pocket costs have creeped up over time

• Customer service has been poor

• Carrier has discontinued the Medicare Part C or D plan

• Legal residence has changed

If any of these events have happened, then a Medicare check-up is in order. September is a perfect time for clients and caregivers to pull some information together to make the task easier when new plan information becomes available Saturday, Oct. 15. Here is a helpful checklist to help people get organized.

• Put together a detailed list of medications. Use the exact spelling and dosage of the medication on the prescription container. Pictures can be surprisingly helpful.

• Collect a thorough list of health care providers' names, addresses and phone numbers. Make sure to include all health care providers such as physical therapists, medical equipment suppliers, laboratories, etc.

• Read the new plan benefit summary the insurance company sends each beneficiary in the end of September. Look at more than just the premium. See if co-payments, co-insurance, deductibles and other plan features will increase next year; call the company or go online to find if all of the medications will be covered this next year and at what costs. Plans are allowed to discontinue coverage of specific medications as well as increasing the cost; do the same for doctors and other health care providers. Ask the health care providers if they expect to continue to participate in the plan.

• Don't assume that a better plan is not available.

• Don't wait until the last minute to shop: Enrollment systems tend to bog down; People who enroll near the end of the Annual Enrollment Period usually start the new year without their new insurance card in hand, making it hard for them to get the care they need.

Right about now you might be thinking that the Medicare check-up can be challenging and certainly time-consuming. While both are true, just like holiday shopping it is easier if you get organized and start early. The good news is that there are several sources of free assistance available to consumers and their caregivers to assist as they sort and sift through options. That said, free support services become overwhelmed quickly. The earlier folks contact them, the more likely they will be available to assist.

Eldercare.gov is a public service of the U.S. Administration on Aging that connects people to services for older adults and their families. This free information and referral assistance, including the State Health Insurance Assistance Programs (SHIP), is available all over the U.S. Visit the elder-care locator online or call 800-677-1116 Monday-Friday, 9 a.m.-8 p.m.

I also recommend cultivating a relationship with a well-established Medicare broker. That professional can be very helpful to your clients and assist them with shopping for Medicare coverages.

If your clients are on Medicare or help someone who is, I encourage them to shop for Medicare Advantage (Medicare C) and Medicare D (for drugs) plans this fall to make sure they are getting the best value for their money. Your clients do not want to be part of the 90% to 95% of folks who overspend on Medicare and waste their hard-earned savings. Once the Annual Enrollment Period window of opportunity closes on Dec. 7, most Medicare enrollees will have to wait until 2018 for new coverage.

Katy Votava, Ph.D., R.N., is president of Goodcare.com, a consulting service that works with financial advisers and consumers on health care coverage.


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