The fine print and the jargon and the tiny language changes — it’s all stuff that makes choosing the right Medicare plan maddening. But a beefed-up federal five-star rating system for Medicare Advantage and prescription drug plans may make the choice a whole lot easier this year.
The new enrollment period opened last Monday for beneficiaries of Medicare Advantage and prescription drug plans. The annual eight-week window allows newly minted seniors — baby boomers who turned 65 this past year — to sign up for policies and for current beneficiaries to reassess their current policies.
There are some general changes worth noting:
Beginning this year, beneficiaries of chronically poor-performing plans will be notified by mail that there might be better options elsewhere and those beneficiaries may switch to the highest-performing plans throughout 2013.
Medicare for the first time will cover screenings for depression, obesity, sexually transmitted diseases and alcohol misuse. It also will cover behavioral therapy for cardiovascular disease.
Under health care reform, Medicare discounts continue to deepen on drugs in the donut hole. This coverage gap is a period of time when seniors must pay a higher cost for prescription drugs — once the full-cost — until they spend enough to qualify for catastrophic coverage. When beneficiaries reach that gap in 2013, they will pay 47.5 percent of the cost for brand name drugs and 79 percent for generic drugs next year.
Knowing the intricacies of your plan may seem daunting, but it’s crucial, senior advocates said.
It’s a case of what you don’t know can actually hurt you — either financially, health-wise or both, said Jennifer Therrien, who helps train about 110 paid and volunteer counselors with the Michigan Medicare/Medicaid Assistance Program. MMAP is a federally funded agency that helps beneficiaries weigh their options.
For example, plans now may choose to cover benzodiazepines, a class of drugs that includes Valium and is used to treat anxiety and insomnia, and certain barbiturates such as those used to treat chronic mental disorders. Those drugs in the past were excluded from Part D and were typically covered out of pocket.
It’s up to individual insurers whether they want to cover those drugs.
“Mental health issues really are problematic for a lot of seniors,” said Kara Zivin, an assistant professor of psychiatry at the University of Michigan whose research has included health policy and Medicare. “A lot of seniors retire and are happy and are living out their lives. But for others, depression, anxiety and sleep disorders — they interact with other health problems.
“It’s real important that these medications are covered the same way (medications for) physical disabilities are covered,” she said.
This expanded drug coverage, along with the screenings that will be covered now for mental health, alcohol misuse and sexually transmitted diseases, are the sort of services that not only thread through a senior’s daily quality of life, they have deep impact on long-term mental and physical health, said Dr. Gwendolyn Graddy-Dansby, a geriatrician and the medical director of the Henry Ford Center for Senior Independence, a Medicare- and Medicaid-funded center that helps seniors avoid nursing homes and remain in their homes as long as possible
That Medicare will now cover those costs signals a shift in understanding to the underappreciated issues that seniors face: “We need to talk about it and take it out of the closet,” she said.
Assessing all the options isn’t easy: Seniors and other beneficiaries must weigh short-term savings in premiums against long-term costs in co-pays or limited benefits. They have to consider developing health concerns and how easily they can get access to a favorite doctor or specialist.
“Every year things change. And with prescription drug plan, the co-pays can change. The premiums can change, and the list of drugs can change. … It can be really frustrating” navigating the information, Therrien said.
Kathy Sutton gets irritated when she has to think of Medicare. She shook her head recently at the Oak Park Senior Center, a community center where — on this particular day — the sound of Bingo filled one end of the building while a game of mah-jongg got under way at the other.
Though most become eligible for Medicare on their 65th birthday, Sutton, 63, already has Medicare coverage because of multiple health problems and disability. She has diabetes, hypertension, arthritis, kidney problems, partial blindness and unexplained tremors. Even with her walker, she has trouble getting around, she said.
“Every time the doctor wants me to see a specialist, it’s going to be another $35, and the last time I went in, they wanted me to see four more specialists,” she said. “I can’t afford that. I need to figure out something.” The good news is that more choices can also drive down prices, said Bettie Hughes, a MMAP coordinator with the Senior Alliance, a federally funded Area Agency on Aging.
“Everyone is trying to jump into Grandma’s pocketbook and get their piece,” she said, “so it can be very beneficial for seniors to look around.”
Easier said than done, said Thurman Page, a retired Detroit police officer.
Like other Medicare beneficiaries, the Oak Park, Mich., resident recently received his copy of Medicare and You, the annual user’s manual from the U.S. Centers for Medicare and Medicaid Services.
Page’s 75-year-old eyes don’t read small print like they used to. “Well, I did get through the table of contents,” he said, chuckling.
Even the informational brochures are printed in type large enough to read, said Betty Mitchell, 89, language can be sometimes jargon-filled and confusing.
“I used to say to my husband, ‘Do you understand this?’ He’d say, ‘Well, about half of it,’” she said.
“It’s like a matrix,” agreed Page.
And in an election year, it’s difficult not to be distracted by the noise of politicians’ promises and predictions.
But this much is clear: Nothing — nothing — has been changed to substantially change Medicare yet. As it stands now, the heart of Medicare — the idea of offering health insurance to Americans 65 and older and those with certain disabilities — remains strong, said Jo Murphy, director of the state MMAP program.
“This is not the time to be anxious,” she said. “This is the time to take action to make sure you
How to save money
To help you navigate the Medicare maze, here are some tips from Gail Jensen, an economics professor at Wayne State University and a researcher at its Institute of Gerontology:
Shop around, even if you’re happy with your current plan. You might be able to save money out-of-pocket while preserving your benefits.
Remember that with Medicare Advantage, there is no need to buy Medigap insurance. Your medications are most likely covered, too — though not always — so there may be no reason to pay for a Medicare Part D drug plan, either.
If you like your current doctor, make a call to the office to make sure he or she still accepts your plan after the new year. Or, if you’re leaving an employer-sponsored plan and want to remain with that doctor, find out what Medicare plans he or she accepts.
Likewise, if you’re new to Medicare but like your current insurance, call your insurer. It might have a Medicare version of your current coverage. That can keep you from switching doctors, changing drug coverage or even switching your pharmacy.
If you’re looking for Part D coverage, focus on the medications that you know you need rather than stressing about medications you might never need. Remember that health care reform is forcing discounts on drugs that fall into the previous coverage gap known as the donut hole.
Remember that the drug plan that is best for you may not be the best plan for your spouse. Most likely, medication and health needs are different, and your most affordable options will differ.
When you’re ready to dive in and compare policies, have a list of medications ready. You’ll need them to compare your options.
Don’t be afraid to enlist the help of your grown children, a trusted friend or trained counselors.