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Medicare Advantage, Part D deadline looms

By Craig Lazzeretti

Assistant managing editor

 

(Wednesday, Dec. 2) For Rossmoor residents looking to change their Medicare Advantage or standalone (Part D) prescription drug plan, the clock is ticking.

Monday, Dec. 7, is the final day of the annual open enrollment period in which Medicare beneficiaries can change their plans for 2021.

And while it may be tempting to forego the headache of navigating Medicare’s complex array of offerings, doing a little homework can add up to big savings and/or better coverage.

The Contra Costa County Health Insurance Counseling and Advocacy Program says it was able to save beneficiaries a combined $31,000 in prescription drug costs at just one open enrollment event last year.

Rossmoor resident Dwight Walker said he was able to save $1,200 in prescription insurance premiums after reading a New York Times article on the importance of reviewing and comparing coverage options.

“There are many choices once you are on Medicare (we are new to it this year) that can be very confusing,” he said in an email to the News.

Why is it so important to review your coverage every year and comparison shop among plans?

“New prescription drug and health plan choices are offered every year,” Contra Costa County HICAP says on its website. “Moreover, plans can and do make changes to their list of covered drugs, provider networks, benefits, copays and more.

“Your needs may have changed too. You may be treated for a new condition or take a new medication that may be more optimally covered by a different plan.”

If it all seems overwhelming, especially with the open enrollment deadline less than a week away, don’t fret. The good news is that there are plenty of resources readily available to give Medicare beneficiaries the information they need to find the coverage that’s best for them.

Contra Costa County HICAP is a good place to start. Go to https://cchicap.org/open-enrollment-information/ to read up on open enrollment and find links to a wide range of plan information and other resources. Compare Part D prescription drug plans at https://tinyurl.com/y2usmg4z and Medicare Advantage plans at https://tinyurl.com/y5on5zjq (there are four new plans for 2021).

Laura Lawrence, an independent Medicare insurance agent who helped Walker find the right plan, advises people to go directly to https://www.medicare.gov, the official U.S. government site for the program. Beneficiaries can enter their ZIP code to compare plans available in their area. They can also enter the specific prescription drugs and dosages they use to find out which of the 32 Part D drug plans available in California are most cost-effective for them.

They also have the option to set up their own account on the site in which they can save all their current prescription and coverage information for future use.

For those who prefer to talk to experts on the phone rather than navigate websites, Medicare can be reached directly at 1-800-MEDICARE (800-633-4227). Or call the Medicare Rights Center consumer help line at 1-800-333-4114 (counselors are available Monday through Friday).

Closer to home, Medicare counseling services are also available through HICAP by calling 1-800-434-0222.

A few things to note when shopping for plans and weighing choices:

  • Medicare Advantage (also known as Medicare Part C) coverage consists of a private insurance plan approved and subsidized by Medicare. These plans offer benefits equivalent to original Medicare (Parts A and B) and usually include drug coverage, so for most people enrolled in an Advantage plan, there is no need to purchase a standalone prescription drug plan (Lawrence said all Medicare Advantage plans available in this area include drug coverage). Medicare Advantage plans may also include dental, vision and hearing coverage.
  • All Medicare Advantage plans in Contra Costa are administered by health maintenance organizations (HMOs), meaning enrollees must use providers in their network. Those enrolled in original Medicare, on the other hand, have the flexibility to see any doctor who accepts Medicare patients. “What people want to weigh is do they want the freedom of choice to go to any doctor they want to,” Lawrence said. “If that’s not an issue and you’re more than happy in your network, Medicare Advantage works fine.”
  • Those enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance) often choose to purchase a Medicare Supplement Insurance (also known as Medigap) plan to provide coverage for gaps in medical costs not covered by Medicare. Medigap policies don’t work with Medicare Advantage plans, so seniors will want to choose one or the other.
  • For those thinking of switching from a Medicare Advantage plan to a Medigap plan, be forewarned that you may be required to undergo a medical underwriting process and there’s no guarantee that an insurance company will offer you Medigap coverage based on your health history and medical conditions. The only time someone is guaranteed eligibility for a Medigap policy is during the person’s six-month Medigap Open Enrollment Period, which starts automatically the first month that the person is 65 or older and enrolled in Medicare Part B (the enrollment period cannot be changed or repeated).
  • When comparing Part D prescription drug plans, keep in mind that plan costs include not only monthly premiums but also annual deductibles and co-payments. Lawrence recommends using the comparison tool on medicare.gov because it will factor in all the various costs for the specific prescriptions the beneficiary needs and provide the least-expensive options.
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