Jake Gariepy, EDN
The Medicare program has instituted an important change to the Annual Election Period for 2012 and many beneficiaries aren’t aware of it. The Annual Election Period (AEP) is the time that Medicare allows members to make changes to their health plan choices for the next year.
The Medicare AEP for the 2012 year began Oct. 15. Unlike past years, this AEP ends Dec. 7, which may leave procrastinators in a scramble.
Also, options for Medicare Advantage plans in Lane County have expanded. In addition to the stalwarts such as Providence, Regence and Health Net, local health insurer PacificSource is entering the market.
Like its competitors, PacificSource offers a variety of plans with varying monthly premiums, from zero to $78.
Since Medicare plans vary, recipients must weigh their options to choose the right plan for their circumstances.
The two different plans are called Medicare Supplement/Medigap and Medicare Advantage and are used in conjunction with the original Medicare benefits.
With Medicare Supplements, plan benefits will be the same regardless of which insurance company you choose. The alphabet soup of standardized plans differs only in premium and in some joining requirements.
Also, Medigap plans do not include prescription drug coverage. Patients with Medicare Supplement may also wish to select a separate prescription drug plan (PDP) at an additional expense.
Medigaps allow patients to see any US doctor who contracts with Medicare. But it is not without its problems.
Continuous cuts in Medicare’s reimbursement to providers have resulted in some doctors refusing to see patients who only have Medicare or Medicare/Medigap plan.
But with a Medicare Supplement, aside from the premium, most members do not have additional cost-sharing. As long as it is a Medicare-covered benefit, the Medigap plan pays the remainder after Medicare has paid its portion.
People who have significant health problems and who know that they may require expensive procedures in the coming year may benefit from this option.
Medicare Advantage plans are very different from Medigap.
Some Medicare Advantage (MA) plans have no premium. Unlike Medicare Supplement plans, MA plans are paid each month by Medicare, which covers the services that original Medicare covered.
MA plans that offer no-premium options have generally arranged the benefits and co-pays in a way that makes it financially feasible to do so. Many of these plans also include prescription benefits, and can be a good choice for consumers seeking to cut costs.
MA’s co-pays for each service or benefit include daily charges for hospitalization, skilled nursing services, emergency room visits and ambulance transport.
Starting at the beginning of 2011, Medicare began requiring all providers to offer preventive services like routine physical exams, colorectal screenings and mammograms, at no cost to members.
Some MA plans require patients to choose one of its preferred providers. Such is the case, too, with many Health Maintenance Organizations (HMOs), which may also demand your primary doctor refer you in order to see a specialist. HMOs will not, in most cases, pay for doctors who are not on their list.
Preferred Provider Organizations (PPOs) work very differently.
If you choose a PPO, you may see any doctor anytime, as long as they contract with Medicare. If you see a doctor that contracts with your particular health plan, you may be entitled to lower co-pays.
Patients who see a provider not affiliated with their plan may have to pay more out of pocket. However, PPOs do no require a referral to see a specialist.
One of the greatest advantages of choosing an MA plan is that most include prescription drug benefits, and there is no additional premium for this benefit.
People who want to change their plan or simply want to get more information should contact the individual health plans, a licensed insurance agent or a SHIBA volunteer. SHIBA volunteers are impartial volunteers who offer assistance to Medicare beneficiaries and can be contacted through the Campbell Senior Center or the Willamalane Adult Activity Center.
NEXT INSTALLMENT: Who needs a plan in addition to Medicare? How do I choose a Prescription Drug Plan?