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.
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. –––