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Medicare open enrollment

By William K. Alcorn

Thursday, November 15, 2012

Many Medicare recipients can possibly save money and get better coverage

By William K. Alcorn |

ONE WOMAN SOUGHT HELP WITH MEDICARE OPEN enrollment and will save more than $1,000 next year in prescription-drug costs.

A counselor saved another Medicare recipient $800 in prescription-drug costs by changing plans.

The message: The results may not be typical, as the weight-loss ads say, but it’s worthwhile for Medicare recipients to check their current plan to see if they can do better in coverage and/or costs, say counselors offering free services.

The annual Medicare open-enrollment window, which began Oct. 15, ends Dec. 7.

For those inundated with information who perhaps threw up their hands and decided it was easier to stay with their current plan than investigate what else is out there, there is still time to get a free benefits check-up.

The lady will save more than $1,000 by switching plans, said Jennifer Adams, long-term care consultant with Area Agency on Aging 11, because the premium on her current plan was going to almost double and her medications co-pays were higher.

“Cost savings is the first reason to do a benefits check-up because each and every year insurance companies change the plans they offer and premiums and deductible may change,” said Adams, a certified Ohio Senior Health Insurance Information Program counselor.

It is also critically important to check plan benefits if the Medicare recipient has developed a new medical condition or changed medications or doctors, a specialist for instance, to determine if the condition and medications are covered and if the new doctor is a network member.

“Their situation may have changed and they may have a Medicare Advantage plan that doesn’t include the doctors they need to see. Doctors come and go on networks,” said Kristen Taylor, admissions and marketing director for Shepherd of the Valley in Niles and Trumbull County OSHIIP coordinator.

At this time of year, Medicare recipients get inundated with literature and many don’t know what to do with it and end up not doing anything. They wonder if something is happening to their plan.

“At that point, we ask them to bring in their information and help them determine if the plan they are in is the best thing for them,” Taylor said.

Counselors feed a Medicare recipient’s health and medications data into a computer program and it “spits out” several best options cost-wise from which to choose.

Retirees losing health coverage through their employer or just turning 65 and going on Medicare may also need some help in deciding which direction to go, such as a Medicare Advantage plan, Taylor said.

The reason for Medicare Advantage plan, under which a private insurance company works with Medicare to provide benefits, is it keeps costs more consistent. Or, if a recipient can’t afford the Medicare supplemental premium, which can run from $100 to several hundred dollars, Medicare is a sort of pay-as-you go option, Adams said.

Another thing the computer program will do, based on medications, is predict when a Medicare recipient will hit the gap, the so-called “doughnut hole,” in prescription-drug coverage.

That may help them determine what plan they want, said Lisa Solley, chief of community relations, wellness, training and human resources at Area Agency on Aging 11.

“We don’t sell plans. We provide options via the computer and offer advice on which plan might best meet their individual needs. Counselors and OSHIIP volunteers do it so much they pretty much know the Medicare ins and outs. I think it’s a good idea to get advice,” Solley said.

Also, she said, many people who qualify for a low-income subsidy, or LIS, don’t know it. It is easy to apply for and it can provide a saving of $4,000 a year for some people, and they never go into the doughnut hole.

While it is easier to do a benefits check-up in the office, Medicare will send a counselor to the residence of home-bound recipients, said Debra Shurilla, licensed social worker at the Mahoning County Senior independence Center in Youngstown.

“Medicare open enrollment is very confusing. The government thinks everyone has a computer and the Internet and can negotiate enrolling in a plan. There are 40 different plans to chose from,” said Jude Signoriello, Medicare counselor at the Girard Multi-Generational Center.

Most seniors are going to a Medicare Advantage plan. They get one plastic card that takes care of medical, lab work, doctor visits, hospital, ambulance and drugs. The advantage plans are simple to use and cost effective.

“My advice: Don’t listen to your neighbor who loves his plan because one size does not fit all. Each plan needs to be individualized,” Signoriello said.