READY, SET, SHOP!
How you can find the best Medicare coverage
If you like choice when it comes to your Medicare coverage, the Sunshine State is the place to be.
Seniors and disabled people living in Central Florida have more options when buying privately run Medicare healthcare and prescription coverage than almost anywhere else in the country, with about 80 to more than100 plans, according to Q1Group LLC, a St. Augustine firm that analyzes Medicare plans.
While that’s slightly less than the number offered in 2014, the numbers of people enrolling in private plans overall is growing. “It’s a trend we expect to continue,” said Gretchen Jacobson, associate director with the program on Medicare policy at the Kaiser Family Foundation.
More than a third of the 13.5 million Floridians on Medicare are on Medicare Advantage HMO-style plans in 2013 and another third are in Part Dstand-alone drug plans, according to Kaiser.
But too much choice can be confusing and overwhelming. That leads seniors to stick with what they have, even though they might discover something better or less costly by shopping around. Anew Kaiser study found seven out of 10 standalone drug plan participants stayed with their providers over a four-year period, despite some that had substantial premium increases.
That’s why experts recommend you carefully look at all your healthcare options as open enrollment nears, even if you are perfectly happy with what you have, since insurers tinker with their benefits every year. Such reviews are particularly important if you are taking different medications, your income has changed, or if you have a new medical condition.
“We stress that people not just look at the premiums to determine if a plan makes sense for them. Look at your individual needs,” said Fred Riccardi, director of client services for the Medicare Rights Center, a nonprofit advocacy organization.
Do side-by-side comparisons so you can easily see differences in premiums, deductibles and drug co-pays.
Howto choose what’s best for you? Start with these basics:
Determine if you need managed care: If you have supplemental health or drug coverage from a previous employer, or if you get your prescriptions from Veterans Affairs clinics, you may do better skipping private Medicare insurers. You can buy a stand-alone drug plan if you have such supplemental coverage that doesn’t include prescriptions, or if you want to stay on traditional Medicare.
Check your coverage: Carefully read your Annual Notice of Change, which you should have received by Sept. 30. It outlines premium, deductible and other benefit changes that will be made to your current plan next year and compares them with what you have now.
State officials say they’ve heard some insurers are shuffling their physician networks in 2014. So ask your doctors if they’re are staying in your current plan’s network and, if not, where they are going.
Look carefully at all out-of-pocket costs: Most plan shoppers focus on the premiums. But those will change little in Florida’s competitive marketplace in 2014, with four out of five of the 86 Medicare Advantage plans in Central Florida’s five-county area continuing not to charge additional premiums beyond what the federal government collects for Medicare Part B.
Seven Central Florida insurers are tacking on additional premiums, ranging from $24 to $135 a month. And16 plans pay a portion of your Part B, putting $11 to $100 monthly back in your pocket. Those who qualify for special needs plans or other subsidies may be able to reduce their deductibles and premiums, in some cases to zero.
Deductibles and some co-payments for hospitals, physicians and drugs will rise next year, however, in most Florida healthcare and stand-alone drug plans. There are some dramatic changes in the maximum out-of-pocket expenses with some plans doubling their maximums up to $6,700, the highest limit allowed by Medicare.
Monthly prices for Florida’s 30 Part D drug plans range from $12.60 to $174.40.
Decide what’s most important to you. No plan will be perfect. If getting care from specific physicians is your main criteria, go with coverage your doctors accept. But be aware: While doctors can drop out of a plan at any time, you can’t.
If you need a brand-name maintenance drug, you may want to focus on plans covering it and which have the lowest co-pay. Make sure your in-network coverage includes your favorite or local pharmacy if you don’t drive far or want to do business with a particular drug store.
And go with plans offering zero copayments or no charge for generic drugs if you’re on a tight budget. Many managed care plans, but not all, cover the routine dental and vision care that regular Medicare does not, although most charge extra for everything beyond an annual routine exam.
Carefully check the drug benefit fine print. Ask about anything additional you may have to pay for your brand name or specialty medications. Also check if your coverage has quantity limits on a specific drug or has “step therapy,” requiring you to try cheaper drugs first before covering a more expensive one prescribed by your doctor.
Can you get discounts? You could get all or part of your Medicare premiums, deductibles or co-payments covered if you have a limited income and resources. Individuals with incomes in 2014 less than $17,235 and assets less than $13,300, and couples with incomes less than $23,265 and assets less than $26,580,qualify for Extra Help subsidies. You also may qualify, even if your income is higher, if you support other family members who live with you or have work earnings. To apply, contact Social Security at 800-772-1213 or go to socialsecurity.gov.