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Medicare: What you need to know this year

By Robin Erb
Detroit Free Press
LIFE SRS-HEALTH-MEDICARE DE
Jessica J. Trevino - MCT
Dr. Gwendolyn Graddy-Dansby, M.D. a geriantrician for Henry Ford Health Systems talks to her patient, Annie G. Watts, 81, after her dialysis treatment at the Henry Ford Center for Senior Independence in Detroit, Michigan, on Thursday, October 11, 2012. Watts is a Medicare recipient and really likes the care she gets at the Henry Ford facility; all of her appointments are handled for her.

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  • How to save money

    • Shop around, even if you’re happy with your current Medicare plan. You might be able to save money out-of-pocket while preserving your benefits.

    • Remember that with Medicare Advantage, there is no need to buy Medigap insurance. Your medications are most likely covered, too – though not always – so there may be no reason to pay for a Medicare Part D drug plan, either.

    • If you like your current doctor, make a call to the office to make sure he or she still accepts your plan after the new year. Or, if you’re leaving an employer-sponsored plan and want to remain with that doctor, find out what Medicare plans he or she accepts.

    • Likewise, if you’re new to Medicare but like your current insurance, call your insurer. It might have a Medicare version of your current coverage. That can keep you from switching doctors, changing drug coverage or even switching your pharmacy.

    • If you’re looking for Part D coverage, focus on the medications that you know you need rather than stressing about medications you might never need. Remember that health care reform is forcing discounts on drugs that fall into the previous coverage gap known as the doughnut hole.

    • Remember that the drug plan that is best for you may not be the best plan for your spouse. Most likely, medication and health needs are different, and your most affordable options will differ.

    •  When you’re ready to dive in and compare policies, have a list of medications ready. You’ll need them to compare your options.

    • Don’t be afraid to enlist the help of your grown children, a trusted friend or trained counselors.



The fine print and the jargon and the tiny language changes – it’s all stuff that makes choosing the right Medicare plan maddening. But a beefed-up federal five-star rating system for Medicare Advantage and prescription drug plans may make the choice a whole lot easier this year.

The new enrollment period is now opened through Dec. 7 for beneficiaries of Medicare Advantage and prescription drug plans. The annual eight-week window allows newly minted seniors – baby boomers who turned 65 this past year – to sign up for policies and for current beneficiaries to reassess their current policies.

There are some general changes worth noting:

• Beginning this year, beneficiaries of chronically poor-performing plans will be notified by mail that there might be better options elsewhere and those beneficiaries may switch to the highest-performing plans throughout 2013.

• Medicare for the first time will cover screenings for depression, obesity, sexually transmitted diseases and alcohol misuse. It also will cover behavioral therapy for cardiovascular disease.

• Under health care reform, Medicare discounts continue to deepen on drugs in the doughnut hole. This coverage gap is a period of time when seniors must pay a higher cost for prescription drugs – once the full-cost – until they spend enough to qualify for catastrophic coverage. When beneficiaries reach that gap in 2013, they will pay 47.5 percent of the cost for brand-name drugs and 79 percent for generic drugs next year.

Knowing the intricacies of your plan may seem daunting, but it’s crucial, senior advocates said.

For example, plans now may choose to cover benzodiazepines, a class of drugs that includes Valium and is used to treat anxiety and insomnia, and certain barbiturates such as those used to treat chronic mental disorders. Those drugs in the past were excluded from Part D and were typically covered out of pocket.

It’s up to individual insurers whether they want to cover those drugs.

“Mental health issues really are problematic for a lot of seniors,” said Kara Zivin, an assistant professor of psychiatry at the University of Michigan whose research has included health policy and Medicare. “It’s real important that these medications are covered the same way (medications for) physical disabilities are covered,” she said.

That Medicare will now cover those and other costs signals a shift in understanding to the underappreciated issues that seniors face: “We need to talk about it and take it out of the closet,” she said.

subhead

Assessing all the options isn’t easy: Seniors and other beneficiaries must weigh short-term savings in premiums against long-term costs in co-pays or limited benefits. They have to consider developing health concerns and how easily they can get access to a favorite doctor or specialist.

Experts also warn that every year, plans, premiums and drug lists can change.

And in an election year, it’s difficult not to be distracted by the noise of politicians’ promises and predictions.

But this much is clear: Nothing – nothing – has been changed to substantially change Medicare yet. –––


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