Making sense of Medicare Open Enrollment

Making sense of Medicare Open Enrollment

MetroWest CARES, the Committee Addressing Resources for Seniors, is coordinated by the Jewish Federation of Greater MetroWest, and brings together leaders from Greater MetroWest agencies to promote independence and support vitality among older adults. Throughout the year MetroWest CARES agencies have the opportunity to address critical eldercare issues in this column. This month’s article on Medicare is presented by Jewish Family Service of MetroWest

Every year, around the time of the Jewish holidays, Medicare open enrollment time comes around. For the 2015 season, the deadline is Dec. 7, 2014. Even if your current Medicare plan and its benefits are working for you, it is a good idea to double-check coverage for the following year. 

There are several factors to consider that could help you save on your health care costs. The first step is to assess your health care needs. Have there been any changes in your health over the last year? How often do you see your health care providers? Make a list of all your medications and dosages. Have you added or eliminated any medications over the last year? 

Have you received any notices from your insurance provider about changes to your plan? Even if you are happy with your current coverage, it may make sense to change your plan to receive even more benefits or lower costs. Plan benefits and premiums are constantly changing, which can benefit consumers.

To make the right decision, it is also necessary to understand the differences between Medicare supplemental insurance and Medicare advantage plans. 

With most supplemental plans, also known as Medigap insurance, Medicare pays 80 percent and the supplemental insurance covers the remaining 20 percent. Not all supplemental plans are the same. For instance, some do not cover the annual deductible set by Medicare. Along with the supplemental insurance, you will need a separate plan for prescription drug coverage, also known as Medicare Part D. These plans have a separate premium.

Medicare Advantage is frequently referred to as Medicare Part C. These plans are administered outside of the Medicare system by private insurance companies. The way it works is the government takes whatever they would have spent on your Medicare coverage and applies it to a private health insurance plan like an HMO or PPO. If you get a plan that is more expensive than the subsidy then you pay the difference. 

The disadvantages to Medicare advantage in the Medigap VS Medicare advantage debate is that, unlike Medigap plans, the Medicare Advantage plans are not standardized. You have to be very careful about which plan you choose and whether or not it has coverage gaps you can live with. Finally you have to be careful about the network of doctors that come with the plan. Your current physician may or may not be a part of that network.

If you join a Medicare Advantage Plan for the first time, and you aren’t happy with the plan, you should have the right to buy a Medigap policy if you return to Original Medicare within 12 months of joining, but always check with the insurance company to confirm this policy.

When comparing different insurance plans, make sure to not only compare monthly premiums, but consider your total out of pocket expenses, including deductibles, copayments, and coinsurance. If you are looking at Medicare Advantage plans, make sure your current health care providers are part of their network. You can start your research at the website or consult a SHIP counselor (State Health Counseling and Assistance Programs). 

Keep in mind that there is no “one size fits all” plan. The variety of choices is complex, but if you want to find the best option for your individual needs for the coming year, don’t hesitate to compare plan benefits and costs during the 2014/2015 Medicare Open Enrollment period.

For a better understanding of what plan is best for you contact a local SHIP counselor. 

• Essex County: Angela Solomon, Newark Day Center, 43 Hill Street, Newark, NJ 07102, 973-643-5710, ext. 29

• Morris County: Nancy Hess, Skylands RSVP Volunteer Resource Center, NORWESCAP, Inc., 53 Stickle Avenue, Suite 2, Rockaway, NJ 07866, 973-784-4900, ext. 208 

• Union County: SAGE Eldercare, 290 Broad Street, Summit, NJ 07901, 908-273-6999

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