D<\/span>espite all the complexities and shortcomings of Medicare, the program offers one compelling saving grace to the 55 million people it covers\u2014an annual enrollment period that, in most respects, permits people to correct any problems with their coverage by signing up for a new set of Medicare policies without penalty.<\/p>\n This annual Medicare open enrollment period begins each year on Oct. 15 and extends through Dec. 7. During this period, you can shop for new Medicare policies and even switch from Original Medicare\u2014Parts A and B\u2014to a Medicare Advantage plan or vice versa.<\/p>\n Despite this annual \u201cdo over\u201d provision, most people don\u2019t change plans\u2014even though studies show that they could save money and improve their coverage by doing so. Doing nothing here means you actually are doing something\u2014automatically re-enrolling in your current plan.<\/p>\n People with Original Medicare have the option during open enrollment of buying a Medicare Advantage plan, which must cover at least what Original Medicare covers. They cannot be denied coverage or required to pay more because of pre-existing conditions. (An exception to this rule is that people with end-stage renal disease are not eligible for a Medicare Advantage plans.)<\/p>\n Likewise, if you have a Medicare Advantage plan, you are free to pick a different Medicare Advantage plan, or you can drop Medicare Advantage and switch to Original Medicare.<\/p>\n Everyone with Medicare\u2014the roughly 70 percent with Original Medicare and the 30 percent with Medicare Advantage\u2014has the option during open enrollment of purchasing a private Part D prescription drug plan or changing to a different Part D insurance plan.<\/p>\n For 2017, active plan shopping can yield big benefits. Each year, the private insurers who sell Medicare Part D prescription drug plans and Medicare Advantage plans\u2014technically known as Part C of Medicare\u2014change key features of their plans.<\/p>\n A plan that was great for you this year may be less suitable next year than other plans. But you won\u2019t know if you don\u2019t do some homework. Fortunately, doing a thorough job of researching Medicare changes needn\u2019t take more than an hour or two.<\/p>\n Here\u2019s your guide to open enrollment.<\/p>\n For starters, more than 40 million people have Part D drug coverage, either through a stand-alone plan\u2014usually abbreviated as a PDP\u2014or wrapped in with a Medicare Advantage plan (MA-PD). With drug prices forecast to continue rising, this year\u2019s open enrollment season presents a terrific opportunity to review your drug coverage and see if there is a better plan for you.<\/p>\n If you already have Medicare, you should have received annual documents from your Medicare drug insurer explaining any important changes in your plan for 2017. This is going to take some time, but your \u201chourly\u201d rate for this reading these documents could be really high\u2014think $100 an hour in possible savings, plus greater peace of mind. I think that\u2019s an attractive return, but it is of course your call.<\/p>\n Here\u2019s what to look for:<\/p>\n Go online to Medicare\u2019s Plan Finder, put in your ZIP code and see what drug plans are offered where you live. Many of these plans, as noted, will be included in Medicare Advantage policies.<\/p>\n Plans make a big deal about holding costs in line, so you will see lots of plans with $0 premiums. If you do not take many drugs, these plans could be a good deal. But here\u2019s a news flash: insurance companies are in business to make money. Those $0 premium plans have to make money somewhere, right? It\u2019s often in the fine print of drug pricing\u2014higher annual deductibles, more expensive copays, and more expensive drug prices.<\/p>\n You can get a rough idea of comparative plan costs for next year by looking at Plan Finder summaries for each drug plan. However, these summaries do not reflect your specific prescription drug needs and costs. Enter your drugs in the Plan Finder formulary section. This will take a little time, and you\u2019ll most likely need to round up your prescription bottles and refer to them. The good news is that once you\u2019ve completed your personal formulary, you don\u2019t need to do it again. It will be stored at Plan Finder and accessible via a password, allowing you to easily compare different plans.<\/p>\n Doing this detailed comparison should give you a good idea of your annual out-of-pocket costs for different plans. This is the number you need to know to really compare plans. Just looking at monthly premiums is not enough and could lead you to make the wrong decision.<\/p>\n You should be able to get online access to insurance-company drug plan formularies. If you\u2019d prefer, the plans will mail you a paper copy. Their phone numbers are included in Plan Finder.<\/p>\n This information should be included in plan formularies as well. Look to see whether the plan is charging you significantly more for these drugs in 2017 than 2016\u2014either through direct increases or by moving the drug from one plan pricing group, or tier, into a more expensive one. Most plans have at least five tiers\u2014preferred and other generics, preferred and other brand drugs, and specialty medications (aka the ones that break your bank if not your financial back).<\/p>\n Even if you see an out-of-pocket total for a drug plan, this is probably not your worst-case financial hit. Under Part D rules\u2014see the \u201cdonut hole\u201d section below\u2014you are still on the hook for up to 5 percent of the cost of a drug in the so-called catastrophic section of plan coverage rules. With some drugs costing $100,000 a year or even more, 5 percent can still be a lot of money.<\/p>\n Nearly all Part D plans now have preferred pharmacy networks. Filling your prescriptions with your plan\u2019s preferred pharmacy provider will save you money, especially on mail-order prescriptions. Even if you can fill a prescription at a non-preferred pharmacy, you may end up paying a higher price. While the plans do publish enormous pharmacy directories, the easiest thing for you to do is call your preferred pharmacy and make sure it is still in the preferred network of your current plan for whichever plans you might be considering switching to during open enrollment.<\/p>\n A new Medicare rule that took effect in 2016 denies Part D coverage for prescriptions that are not written by a provider who is enrolled in Medicare\u2014most are\u2014or has a formal exception from the agency. While this is not likely to trip you up with a physician\u2019s prescription, there are many other professionals authorized to write prescriptions, and they also need to be enrolled. In particular, make sure you check with dentists who write prescriptions to make sure they\u2019re enrolled. This is a preventable surprise you don\u2019t want to get!<\/p>\n Once you\u2019ve paid your drug plan\u2019s annual deductible, Part D rules covered you until you and your plan had spent $3,310 on covered drugs in 2016. Then, a so-called coverage gap kicks in and strips you of all insurance until total costs hit $4,850. These numbers will be updated later this year for 2017. While in this gap, or donut hole, in 2017 you will pay 40 percent of the cost of brand-name drugs and 51 percent of the cost of generic drugs.<\/p>\n Under terms of the Affordable Care Act, the donut hole will disappear by the year 2020, at which time your copay for all drugs\u2014branded and generics\u2014will never be more than 25 percent.<\/p>\n When total costs reached $4,850 in 2016, you will enter the catastrophic phase of plan coverage and will pay only a few dollars for each prescription or 5 percent of the cost, whichever is greater. Again, this ceiling will change in 2017.<\/p>\n Millions of Medicare beneficiaries receive financial assistance from Medicare to pay for their Part D drugs and even their insurance premiums. The Extra Help program can be complicated, so I recommend you get free help by calling a counselor in your state with the State Health Insurance Assistance Program (SHIP).<\/p>\n Medicare Advantage plans must cover everything that Original Medicare covers. Many plans actually cover more, including hearing, vision, dental and even gym memberships. They combine these features in a single insurance policy, usually including Part D drug coverage, and it often costs less than Original Medicare, Medigap and a stand-alone Part D drug plan.<\/p>\n Original Medicare allows you to use any health care provider that accepts Medicare, and nearly all do. Not so with Medicare Advantage plans. One of the primary reasons they can afford to offer additional coverage features is because most of them require people to get their health care needs from a provider network created and managed by the plan. These networks can create big savings for insurers, but can also sharply restrict health care provider choices for Medicare beneficiaries.<\/p>\n Here are three shopping tips for Medicare Advantage plans:<\/p>\n Check out the Centers for Medicare & Medicaid Services\u2019s (CMS) five-star rating system for Medicare Advantage plans, which is based on more than 30 variables (there are additional measures used when rating Medicare Advantage Prescription Drug plans).<\/p>\n Low Medicare Advantage premiums and zero premium plans may be appealing at first glance. However, as I\u2019ve been stressing and stressing, premiums are just one cost component of Medicare coverage. You also need to look at plan deductibles, coinsurance, and copays.<\/p>\n The largest out-of-pocket exposure that Medicare allows for these plans is $6,700 this year for health coverage, and most Medicare Advantage plans have lower ceilings. There can be a separate ceiling for out-of-network health costs, which apply to Medicare Advantage \u201cPPO\u201d or preferred provider organization plans. Medicare Advantage Prescription Drug plans include yet a third out-of-pocket number for drug costs.<\/p>\n You don\u2019t want to sign up for a new Medicare Advantage plan only to learn that your doctor is not in the plan! Insurers have online search tools to let you know if your preferred physicians, hospitals, and other care providers are in their provider networks.<\/p>\n People with Original Medicare\u2014Parts A and B of Medicare\u2014can also choose whether they want to buy a Medigap policy, also known as a Medicare supplement policy. And people who already have a Medigap policy can buy a different Medigap policy.<\/p>\n Medigap policies fill, to varying degrees, the holes in Original Medicare. The biggest hole is that Original Medicare pays only 80 percent of covered expenses, leaving beneficiaries on the hook for the other 20 percent. As anyone who\u2019s stayed in a hospital or had major surgery knows, that can be 20 percent of a very, very big number.<\/p>\n If you don\u2019t have Medigap or even if you do, you can select a Medigap plan during open enrollment. There are 10 different Medigap \u201cletter\u201d plans. Coverage within each type of plan must be identical. This means that all letter A plans are the same, all letter B plans and so on. But premiums can and do vary a lot. So shopping around for the best rate is a must. Specific coverage requirements of the various plans are included in the annual \u201cMedicare & You\u201d guide that the government publishes each year.<\/p>\n People with Original Medicare who switch to Medicare Advantage cannot keep their Medigap plan should they have one. Medigap plans do not provide any coverage to people with Medicare Advantage.<\/p>\n People have guaranteed rights to Medigap policies on favorable terms when they\u2019re first eligible for Medigap. But later on, these rights are not available in many states, possibly adding to Medigap policy costs and perhaps even restricting their availability.<\/p>\n So if you\u2019re thinking of changing Medigap policies, check with your state insurance department or call a counselor with the State Health Insurance Assistance Program (SHIP) to learn about rules where you live. And if you drop Medigap as part of a switch to a Medicare Advantage plan, you should consider these consequences should you wish to return to Original Medicare with a Medigap policy in the future.<\/p>\n Good luck in finding your best Medicare solutions!<\/p>\n Philip Moeller is an expert on retirement, aging, and health. He is co-author of the recently updated New York Times bestseller, <\/em>Get What\u2019s Yours: The Revised Secrets to Maxing Out Your Social Security. His companion book, <\/em>Get What\u2019s Yours for Medicare: Maximize Your Coverage; Minimize Your Costs, has just been published. Reach him at moeller.philip@gmail.com<\/a> or @PhilMoeller on Twitter.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" Making sense out of complicated Medicare choices<\/p>\n","protected":false},"author":3,"featured_media":757,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[62,63],"tags":[],"class_list":["post-4321","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-fall-2016","category-fall-2016-columns"],"acf":[],"_links":{"self":[{"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/posts\/4321","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/comments?post=4321"}],"version-history":[{"count":6,"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/posts\/4321\/revisions"}],"predecessor-version":[{"id":4608,"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/posts\/4321\/revisions\/4608"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/media\/757"}],"wp:attachment":[{"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/media?parent=4321"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/categories?post=4321"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/tags?post=4321"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}Understand the Basic Choices You Have<\/h4>\n
Part D Plans<\/h4>\n
1. How will your overall costs change next year?<\/h4>\n
2. Are all your prescription drugs still included in your plan formulary (the list of prescription medicines covered by the plan)?<\/h4>\n
3. If you take any expensive medications, how will they be treated?<\/h4>\n
4. Can you still get your prescriptions filled at your local pharmacy and at what price?<\/h4>\n
5. Are your prescriptions written by a Medicare-enrolled provider?<\/h4>\n
6. What does the coverage gap\u2014also known as the donut hole\u2014look like?<\/h4>\n
7. Is your income low enough to qualify for Medicare\u2019s Extra Help program?<\/h4>\n
Medicare Advantage Plans<\/h4>\n
Pay attention to plan ratings.<\/h5>\n
Look at total out-of-pocket costs.<\/h5>\n
Find out who\u2019s in your Medicare Advantage plan provider network.<\/h5>\n
Medigap<\/h5>\n