Jehlen: Review your Medicare Options, Save Money

– State Senator Pat Jehlen (D-Somerville, Medford)

The annual Medicare enrollment period is earlier than usual this year, starting October 15 and lasting through December 7. During this window, and only during this window, you can review your Medicare Advantage and prescription drug plans’ coverage options. While reviewing your Medicare coverage is not necessarily an exciting prospect, it is certainly important. Ensuring that you are in the most cost-effective plan for your medical needs can save you hundreds of dollars.

Medicare can be complicated; it’s important to understand what is actually covered. You should start by reviewing Medicare Parts A and B and seeing how they match your needs. Next, see if a Medicare Advantage plan or Medicare Supplement plan fits your health care situation. Finally, evaluate what sort of prescription drug plan you will need.

Luckily, you do not have to make all these decisions on your own. Qualified professionals are available to help you understand your options. The SHINE Program (Serving Health Information Needs of Elders), a state health insurance assistance program, provides free health insurance information, counseling and assistance to Massachusetts residents with Medicare. Administered by the Massachusetts Executive Office of Elder Affairs, SHINE counselors are available through the Medford Council on Aging and Mystic Valley Elder Services.

For those dually eligible for Medicare and Medicaid, Senior Care Options (SCO) plans and Programs of All-Inclusive Care for the Elderly (PACE) are proving to work well for their members in Massachusetts by providing high-quality comprehensive case management of health care, housing, and other services; contact Mystic Valley Elder Services for consultation and referral.

The full implementation of Obamacare over the next couple of years makes reevaluating your Medicare options even more important. You will notice many positive changes and reviewing options will maximize your savings. Most notably, Obamacare will close the Medicare Part D “donut hole.” Currently, if your yearly prescription drug costs exceed a certain amount ($2,930 in 2012), but your out-of-pocket costs have not reached the point where you qualify for “catastrophic coverage” ($4,700 in 2012), you fall into the donut hole. Starting in 2012, seniors got a 50% discount on brand-name prescription drugs and 14% discount on generic prescriptions. These discounts will increase incrementally until 2020, when 75% of prescription drug costs for people in the donut hole will be covered by Medicare.

In addition to closing the Medicare Part D donut hole, Obamacare has many other benefits for those on Medicare. Preventive care services will be free. These include a yearly wellness visit as well as mammograms, colonoscopies, and screenings for diabetes. Medicare Advantage plans that receive high ratings will now receive bonus payments, incentivizing better quality care. Some of that bonus money must be spent providing extra benefits or providing rebates to people on the plan. There are also regulations ensuring that Medicare Advantage plans do not spend more than 15% of premiums on overhead, guaranteeing that more money goes to providing care.

In this changing health care landscape, it is vital that you take an afternoon and review your coverage options. It can save money, improve your coverage, and help make your life healthier and happier.