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Medicare open enrollment: What you need to know



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Medicare’s enrollment period – that once-a-year opportunity for beneficiaries to change Medicare insurance plans for the upcoming calendar year – is now open through December 7.  

And while about 95 percent of beneficiaries stick with the coverage they have, reviewing your 2015 plan options is a worthwhile investment that can save you money and frustration, says David Sayen, regional administrator with the Centers for Medicare and Medicaid Services (CMS).

"Look at your coverage, make sure it’s covering what you need," Sayen says. "And more important: is it going to cover what you need next year?"

In particular he says, you’ll want to review whether your plan will still cover your preferred doctor and hospital in 2015.  Are the prescriptions you take still going to be covered? And can you continue buying your drugs at your local pharmacy?

What’s more, while Medicare plans are fairly similar to one another,  in that they are required to cover certain services and benefits, some offer additional perks. 

So how do you figure out what’s best for you?

To help you better navigate your 2015 Medicare choices, we’ve got answers to 10 frequently asked questions.

1. How long does Medicare open enrollment last?

From Oct. 15, 2014 through Dec 7, 2014

2. What are my choices for Medicare coverage? 

The main choice is between the two categories of Medicare health plans:  

Original Medicare, which is the default enrollment category and Medicare Advantage plans, which is a category you can opt into.  This category includes a variety of plans run by private companies, such as Kaiser Permanente and Heath Net. Typically, these Medicare Advantage plans make annual changes. If you’re enrolled in one of these plans, you should have already received a notice in the mail that outlines all the changes in next year’s plan. Make sure to carefully read them. 

3. What is Original Medicare?

Original Medicare is the traditional fee-for-service program offered directly through the federal government. It combines hospital insurance ("Medicare Part A") and medical insurance ("Medicare Part B").  Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services and durable medical equipment, among other things. 

If you have this plan, you can see any doctor or go to any hospital nationwide that accepts Medicare and the government pays the provider directly for the services you receive.  It can be a good choice for folks who live in more than one geographic region during the year, Sayen says.  Under Original Medicare, there are limits on what a provider can charge you and you will be expected to pay part of the cost for each service.

CMS advises those with Original Medicare to consider supplemental insurance from an employer or from a "Medigap" policy designed to bridge the gap between what Medicare pays and your out-of-pocket costs, which, depending upon the procedure, can be high.

As long as you paid Social Security taxes for 10 years, there is no monthly premium for Part A. For most seniors who have Original Medicare, the 2015 Part B premium will stay unchanged for a second consecutive year, at $104.90.  The Part B deductible will stay the same as well.

A caveat: Original Medicare doesn't include a drug plan, so enrollees who want prescription coverage must choose a separate Prescription Drug Coverage plan ("Medicare Part D") offered by private companies.

4. Do I need to do anything to stay in Original Medicare?

If you're content with your Original Medicare coverage, you can sit tight, as there  are no significant changes to consider between the 2014 and 2015 plans, Sayen says.  However, because Original Medicare doesn't include a drug plan, it is wise to review your Part D drug plan as the medications it covers, the pharmacies it works with and the premiums may be changing.

5. What are Medicare Advantage Plans ("Medicare Part C")?

If you think Original Medicare doesn't help pay for enough services; if you think Medicare Part D costs too much;  if you want to cap your out-of-pocket expenses (Original Medicare has no cap), or if  you want an alternative to buying Medigap coverage, you might want to consider a Medicare Advantage plan.

This category includes HMO's, PPO's and other plan options offered by private companies. Some Medicare Advantage plans help pay for eyeglasses, dental care, assisted living facilities or nursing home care. Most – but not all - Medicare Advantage plans include drug coverage. But don’t assume the plan you want includes drug coverage, as a handful of L.A.-area plans still do not, in which case you’ll have to purchase a separate plan for your prescriptions.

If you're considering a Medicare Advantage plan, you'll find fewer plans available in 2015, but still plenty of options from which to choose, Sayen says. The average premiums for these private plans will climb from $27.04 a month to $33.90 a month.  But that’s just a national average and says nothing about whether the premium in your plan went up or down.  So be sure to take a look at your 2015 premiums and also consider the plan’s co-pay and deductible costs.

6. Is there a way to measure the quality of a Medicare Advantage plan I’m considering?

Yes. Medicare offers a five-star rating program, informed partly by member surveys, for each plan that’s available on its website. 

7. Do I need to do anything in order to stay in my existing Medicare Advantage Plan?

Not if it's working for you. But make sure to confirm that any pending changes in the plan aren't deal breakers for you.

To do that, you’ll first want to take a look at any changes in your Medicare Advantage plan outlined in a letter sent to you from your carrier.  Next, take a peek at the Medicare plan booklet that also landed in your mailbox within the past few weeks, or check out the online guide. There you’ll find all the plan details, including information about premiums, out-of-pocket costs and ratings for those 2015 plans available in your local area.

If your plan is among the few that don't include prescription drug coverage, it's important to review any changes to your drug plan and, if necessary, choose another. Also, unlike Original Medicare, which travels wherever you go in the United States, Medicare Advantage plans may not be accepted in all regions. So if you take up residence elsewhere during part of the year, make sure your plan will cover you there.

8. What are Medicare Prescription Drug Plans (“Medicare Part D”)?

These Medicare-approved plans are offered by private insurance companies to provide coverage in conjunction with Original Medicare (which doesn’t provide drug coverage) and with those handful of Medicare Advantage Plans that don’t provide drug coverage. 


One giant caveat:  If you’re enrolled in a Medicare Advantage Plan that does provide drug coverage and if you also enroll in a separate prescription drug plan, you will be dropped from your Medicare Advantage Plan and enrolled instead in Original Medicare.  So be sure you check before making any moves.

And remember: drug plans change, so make sure to review whether the medications you need are still covered.

9. Is there help if I can't afford my Medicare Prescription Drug Plan ("Plan D") costs?

Yes. It's called the "Extra Help" program through the Social Security Administration. To qualify for help with monthly premiums, co-pays and deductibles, you must be receiving Medicare and meet certain income and asset tests.  You can also call Social Security for information about the program at 1-800-772-1213 (TTY users should call 1-800-325-0778). 

10.  Help! Can someone guide me through all these Medicare choices?

Yes. Among the resources available to Medicare beneficiaries: