Medicare Plan Review

March 15, 2013

Have you done your yearly Medicare plan review? Medicare open enrollment will be ending on December 7. Each year, there are new health plan and prescription drug coverage choices. You should review your current health and prescription coverage each fall.


What can we do during Medicare open enrollment?
During the open enrollment period you can change from Original Medicare to a Medicare Advantage Plan, most of which are HMOs run by private companies. Or, you may switch from a Medicare Advantage Plan to Original Medicare.

If you choose Original Medicare, you likely will need to buy supplemental insurance to pay for your co-insurance and deductible costs. (Medicare only pays 20 percent of the doctor’s approved fee.) If you choose Original Medicare, you also should decide now whether you want to keep or add drug coverage under Part D. Many Medicare Advantage Plans include drug coverage.

Q: Is the cost of the Medicare supplemental plan in which we’re enrolled going to change?

A: By now, you should have received an annual notice of rate changes from the Medicare supplemental insurance or Medicare Advantage Plan in which you’re enrolled. The notice will describe what the plan costs are going to be for 2012 and if there are any changes. If you haven’t received a notice, call your health insurance carrier and ask for one.

Q: Do I need supplemental drug coverage?

A: There is a lot to think about when it comes to Medicare drug coverage. As with choosing a plan, cost is just one consideration, but not the only factor that should be part of your decision.

Even if you’re not taking a lot of prescription drugs now, consider joining a Medicare drug plan because you will pay a late enrollment penalty if you choose to join later. You will pay this penalty as long as you have a Medicare drug plan.

When considering which drug plan is right for you, ask these questions of your pharmacist and plan provider:

  • Is the pharmacy I use in the plan? If not, are there other options that are equally convenient?
  • Must I use mail-order? Some drug plans require you to do so, while others do not.
  • What are the co-payments for generic and brand-name drugs? If you use a lot of generics, you might be interested in plans with tiers that charge you little or nothing for generic drugs.
  • What is the yearly deductible for drug coverage? Deductibles can vary–some drug plans have no deductibles but higher monthly premiums. You have to do the math.
  • What drugs are on your formulary? A formulary is the list of drugs that the Medicare drug plan covers, and it includes how much you pay for them. Each drug plan has its own formulary, so check that your drugs are covered. Of course, your health and prescriptions may change later, so it can be hard to know which plan is ideal for you.

California Health Plans has licensed agents that have a vast amount of knowledge about Medicare. Call 1-800-585-1776 and ask to speak to agent specialized in Medicare.

Post author Loren Pleet