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State Sen. Jehlen: 'Review your Medicare Options, Save Money'

Medicare recipients have until Dec. 7 to review their coverage options, and there are services available to help people navigate all the confusion, Somerville's state senator says.

The following is from Somerville State Sen. Patricia Jehlen. She reminds people they have until Dec. 7 to review and make enrollment changes to their Medicare coverage.

She also has advice for people who would like to consult with an expert about their options.

Here's what Jehlen writes:

Review your Medicare Options, Save Money

 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 Somerville Council on Aging and Somerville Cambridge 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 Somerville Cambridge 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.

dennis byron November 12, 2012 at 01:52 PM
In addition to being inaccurate in some places, this politician's letter appears to be a year old. 1. It is not true that “the annual Medicare enrollment period is earlier this year.” It is the same as last year. But it is true that by December 7 you should ideally make changes to Medicare Parts C and D plans if you currently have one of those plans or are thinking of getting one of those plans. In Massachusetts, you can make changes to your Medigap plan anytime. If – like the plurality of seniors in Massachusetts – you are on an employee-retiree plan, you have to decide during whatever time period the former employer says. 2. It is not true that “During this window, and only during this window, you can review your Medicare Advantage and prescription drug plans’ coverage options.” There are many exceptions to that rule. In particular, in Massachusetts, any senior on the Prescription Advantage state pharmaceutical assistance program can change their plan one additional time during the year. And over 80% of Massachusetts seniors are eligible for Prescription Advantage. But it is true that this is the best time of year to “review” because the prices and other Part C and Part D Medicare plan rules change January 1.  Other errors noted on other commnets
dennis byron November 12, 2012 at 01:54 PM
Other numbered errors noted in other comments: 3. I am not sure what the politician means by saying “You should start by reviewing Medicare Parts A and B and seeing how they match your needs.” It’s not like you can do any thing about how they “match your needs” and the easy answer to the question is that Medicare Parts A and B only match your needs if -- You don’t mind paying around $1200 any time you are admitted into the hospital next year and -- When you go to the doctors or an outpatient facility or the ER or are observed at a hospital (but are not admitted), you don’t mind paying 20% of the charge (after a $150 annual deductible) and -- You don’t mind paying 100% of your drug costs, routine eye and hearing care, annual physicals, dental services and many more things not covered by Medicare Parts A and B and -- You don’t mind taking the chance that any hospital charges you do incur will exceed Medicare Parts A and B lifetime limits HINT IF THIS IS HARD TO FIGURE OUT: 95% of other seniors have already decided Medicare Parts A and B do NOT “match their needs” and they find other usually private options.
dennis byron November 12, 2012 at 01:55 PM
Other numbered errors in other comments: 4. I am not sure what the politician means with “The full implementation of Obamacare over the next couple of years makes reevaluating your Medicare options even more important.” Perhaps: -- The politician means steer away from Part C Medicare Advantage because Obamacare is projected by the Medicare actuary to increase Part C Medicare Advantage monthly premiums or reduce Part C Medicare Advantage benefits dramatically, forcing millions of seniors to choose between no supplemental coverage or more expensive Medigap coverage. -- The politician may also mean steer away from Medigap Supplement-1 in Massachusetts (Medigap Plans N and F in other states) because Obamacare will do away with these Medigap plans’ first-dollar coverage in 2014. -- The politician means stay away from small hospitals and nursing facilities because Obamacare will make major cuts in Medicare reimbursements to hospitals and nursing homes staring in 2012, forcing many – presumably the smaller ones -- to incur large losses according to the Medicare actuary. -- The president is also proposing major changes in Part D Medicare drug coverage but that is not part of Obamacare.
dennis byron November 12, 2012 at 01:56 PM
Other numbered errors in other comments: 5. It is not true that “Obamacare will close the Medicare Part D “donut hole.” The donut hole affects less than 5% of seniors in Massachusetts anyways but it is not true that the donut hole will be closed. What Obamacare does is eventually provide the same discount in the hole as in the so-called initial spend phase of Part D. However, the hole is still there and there are sure to be unintended consequences of Obamacare’s approach. (As noted above the president is proposing other major changes to Medicare drug coverage, at which time we’ll really find out why he kept the hole.) 6. It is not true that “Preventive care services will be free” under Medicare because of Obamacare. Some are free but most still require a 20% co-pay. Most of the services that are free – like flu shots – were always free in Massachusetts. And some of the free services such as mammograms and PSA tests have been discovered to be ineffective. 7. It is not true that with Part C Medicare Advantage plans, “Some of that bonus money must (now) be spent providing extra benefits or providing rebates to people on the plan.” That has always been the case and has nothing to do with Obamacare. And, as noted above, it’s kind of hard to even talk about the Obamacare bonus program – which the GAO has ruled illegal – because the Medicare actuary has predicted that Obamacare will obliterate Part C Medicare Advantage by 2020.
AHM November 12, 2012 at 02:53 PM
I just discovered the donut hole this year when in July I went to pick up my prescriptions and they wanted a $750 copay. Needless to say I had to cancel my drugs. Now I am waiting for Jan. 1st to either start taking them again or just do without. By what I read it doea now seem so much different this year as next year. So I may as well not bother if I can't take them all the time. So hard to understand all of this until it happens to you.
medservicewebpap November 20, 2012 at 07:35 AM
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