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By Gail Glockhoff-Long
GolderCare Solutions

Medicare Open Enrollment – Why Should You Care?

If you are currently on Medicare, you have probably received an open enrollment letter in the last few weeks.  What does this mean to you?

It means this is your once-a-year chance to change from your current plan to a different plan. In an effort to control healthcare costs, Medicare restricts the time period during which consumers can enroll in Medicare plans. Open enrollment is allowed only once a year during the Medicare Annual Enrollment Period. The Annual Enrollment Period for 2016 Medicare coverage is from October 15, 2015 through December 7, 2015.  Your 2016 plan takes effect on January 1, 2016.

With some exceptions, this Annual Enrollment Period is the only time of the year in which you can change your Medicare plan.  So it’s important to review your current coverage at this time of year and evaluate whether you need to change plans.

Here is a quick primer.  Medicare has several parts.

Parts A and B are known as Traditional Medicare. Part A is for hospital inpatient coverage (including medications while admitted to a hospital). Part B pays for physicians and outpatient services (including outpatient services received while in the hospital under observation). For most Medicare beneficiaries, there is no premium for Part A coverage. Part B monthly premiums are generally deducted from your Social Security check.

Traditional Medicare was designed with premiums, deductibles and co-pays. It doesn’t pay all  medical expenses.  To fill in some of these gaps, many Medicare beneficiaries also purchase a private Medicare Supplement (or Medigap) policy. Medigap policies are regulated by Medicare and are offered as standardized plans. The standardized plans differ by what they cover – high deductible, low deductible, coverage for foreign travel, low co-pays, etc.  To make things even more confusing, these standard Medigap plans are also designated by letters – A through N. Be careful not to become confused by the alphabet soup. For example, keep straight whether you’re referring to Part D (drug coverage) or Plan D (a level of Medigap protection). Medicare’s Part D is newer than Parts A and B. It pays for prescription drugs.

Some people have Part C in place of Parts A and B.  Those who subscribe to Part C receive what is known as an Advantage Plan in place of Traditional Medicare. If you opt for Part C, Medicare doesn’t pay the cost of your care directly.  The health insurance company does. Instead, Medicare pays the insurance company what essentially amounts to an
insurance premium, just as you would if you were purchasing a private policy of health insurance. Advantage Plans are a form of managed care offered in place of Parts A and B and, often, part D.  The Advantage Plan trade-off is a limited list of medical providers for a lower premium.

As medical costs continue to rise and government mandates of insurance coverage change, insurance companies must continually look for ways to keep costs down and remain profitable. To that end, they keep adjusting coverage and premiums each year.  Advantage plans are particularly susceptible to yearly changes in coverage. Advantage plans are also county and state specific. A pool of money is given to a state and insurance companies contract to cover enrolled residents of a particular county for a set amount of reimbursement from the state Medicare pool of funds.  In our area, the contract for Scott County may be different than the contract for Rock Island County for the same insurance company. If you are talking to an insurance professional about Advantage plans, make sure they are reviewing coverage for your county.

There are several different companies offering Advantage Plans. The AARP plan is a popular Advantage plan in Rock Island County so let’s look at some of the AARP Advantage changes for 2016.

•  The premium will remain the same at $39 per month and will continue to cover Part D.
•  The total maximum out of pocket amount and primary care doctor co-pays go down.
•  Emergency Care co-pay went up a little.
•  The co-pay for Skilled Nursing went up from $155 to $160 per day.
•  The co-pay applies to days 21 to 45 instead of days 21 to52 (This means for a 60 day stay in Skilled Nursing the copay was $4805 in 2015 but will only be $3840 in 2016).
•  The co-pay for drug list tier 5 will go down from 33% to 28 percent.
•  The co-pays for the other drug tiers remained the same.
•  The list of in-network providers and covered drugs change every year.  Always review the current list for your providers and medications. How did your plan work for you last year?  Review the material sent by your insurer for any changes for 2016. Pay particular attention to the following changes:
•  How will any of the changes to benefits and costs affect you?
•  Check the prescription drug coverage, drug tier list and co-pay changes for your medications.
•  Make sure your doctors and other providers are still in thenetwork.
•  Check the maximum out of pocket expense changes.

Were you satisfied with your plan last year?  If there are any changes for 2016, will the plan still work for you?  If yes, stay with the coverage you have.  You don’t need to do anything.  A new insurance card will generally arrive in late December.

If, however, your coverage didn’t work well for you – it may be time to shop for a different plan that better fits your current needs.  If a change is needed, contact your insurance professional in November so there is time for all of the paperwork to be completed before December 7, 2015.  Sooner works better than later.

Gail Glockhoff-Long has advocated for her mother and sister.  She is the GolderCare Solutions Office Manager and Benefits Advocate specializing in insurance and can be reached at 309-764-2273 or at the GolderCare office located at 4101 John Deere Road, Suite A, PO Box 1071  in Moline, IL. GolderCare Solutions provides long term care solutions for both Iowa and Illinois clients.

Tiffany Whittaker is a Benefits Advocate for GolderCare Solutions. She uses her diverse knowledge and experience in benefits planning to advocate for seniors and those who are disabled.  GolderCare Solutions provides long term care solutions for both Iowa and Illinois clients.  You can reach Tiffany at GolderCare Solutions Unlimited, LLC (309) 764-2273