Medicare Open Enrollment Period

Medicare Open enrollment  is here. Time for American seniors aged 65 and older to make changes to their Medicare health coverage or switch to Medicare from managed plans. Medicare Open enrollment is from Oct. 15th through Dec. 7th, 2015.  There are several parts to Medicare and they are not free. Traditional Medicare pays 80% of costs for most health care and therefore a supplemental, or “Medigap” plan is often purchased to cover the other 20% of costs. Since many things change, your health, medications, the premiums, the plans, your doctor’s affiliation etc. it is prudent to use this period to evaluate your current health coverage needs. Medicare part D – the drug plan definitely should be reassessed as your medications may have changed greatly since last year and another Part D plan may be better suited to your current needs. Boomers may wish to discuss the different plans with their parents.

The 4 Parts of Medicare:

Part A covers hospital, skilled nursing (rehab), hospice and some home health care (Nurse and Therapy visits) it is usually free if you have the Social Security requirement of having a minimum of a 10 year work history in the U.S. If you don’t have that work history, the premium is set by how many work credits you do have. (Such premiums can be up to $407. a year).

Part B covers doctor visits, outpatient care/therapy, preventive care and some hospital and home health care.  The premium is based on annual income; typically the premium in 2015 is $104.90 a month.

Part C is also referred to as Medicare Advantage or Managed Care and is based on the HMO/PPO model. It is a substitute for Parts A, B and often D. Premiums will average around $32.60 a month (in 2016) and are based on location and coverage.

Part D is the coverage for prescription medications and premiums range from $15-$50 a month.

So, each Older Adult must consider his or her own health/medical profile and needs, what they can afford and how much freedom of choice matters to them. Managed Plans (Part C) have lower costs but they require you to use only doctors, hospitals and rehab centers in their “network”.

You may see a two tier choice emerging, based on health and finances. Medicare open enrollment  offers greater choice and access to specialists, does not require “approval” for certain treatments but is costlier and you will likely add a supplemental policy to it. Managed plans are less costly and many also have vision, dental and hearing coverage, but you are restricted to their network and your care is managed by the managed care company. It becomes a cost vs. freedom decision b based on your individual health outlook and the medications you need.

Medicare can be reached at 1-800 MEDICARE or online at www.medicare.gov. Should you choose to remain with or return to traditional Medicare, you will want to review your Part D medication coverage as meds are most likely to change from year to year. Discuss your medications and generic alternatives with your doctor and your pharmacist.

Non-medical care at home is not covered through Medicare. In-home caregivers and aides are paid for through Long Term Care insurance or out of pocket. This is custodial care and can be up to 24 hours a day.