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Do IT this week: Layering
Open enrollment starts Saturday. Agency advises that you check drug plans for changes, costs
By Cheryl Powell
Beacon Journal medical writer
Published on Sunday, Nov 09, 2008
For thousands of Ohio residents who get their drug coverage through Medicare-approved plans, now's the time to start taking inventory of their medicine cabinets.
Open enrollment starts Saturday and continues through Dec. 31 for Medicare's optional prescription drug program, also known as Medicare Part D.
During the open enrollment, people covered by Medicare also can sign up for Medicare managed-care plans, which help pay for medical costs and, in many cases, include prescription drug coverage.
Both types of plans are available — but not required — for everyone covered by Medicare, the federal health program for people ages 65 and older and some younger disabled Americans.
Experts recommend enrolling by early December to make for a smoother transition Jan. 1.
In Summit County, about a third of the more than 88,700 Medicare recipients are enrolled in a Medicare managed-care plan, according to Medicare data. Another 21,600 people are enrolled in a Medicare Part D plan.
Regardless of the plan they've selected for this year, consumers shouldn't assume their coverage will be the same next year, said Francine Chuchanis, ombudsman supervisor for the Greater Akron/Canton Area Agency on Aging.
Just because a drug is covered this year doesn't mean it will be covered next year at the
same price or without restrictions, such as quantity limits or requirements to try other drugs first, she said.
''People really need to yearly look at the drug coverage,'' she said. ''There might be a better plan. Cost might be different.''
Medicare drug plans and managed-care plans are required to notify enrollees about any major changes in coverage.
This year, many plans are expanding the number of prescription drugs they cover, a list known as a ''formulary,'' said Gretchen Lopez, program director of the Ohio Department of Insurance's Ohio Senior Health Insurance Information Program. ''We're seeing some of the more experimental drugs, now they're being added to the formularies, which is good news,'' she said.
Retirees who get their coverage from a former employer or union also should have received a notice indicating whether their plan is considered ''creditable coverage,'' or at least as good as Medicare Part D plans.
Retirees with creditable coverage usually are better off keeping their plan, Chuchanis said.
Anyone who loses creditable coverage can sign up for a Medicare prescription drug plan within 63 days after losing coverage without paying a late-enrollment penalty, Lopez said.
Drug plan options
Next year, the 1.8 million Ohio residents covered by Medicare will be able to choose among 49 drug plans.
Overall, more than three-fourths of Medicare prescription drug plans in Ohio are increasing monthly premiums in 2009 for the same or similar coverage.
Enrollees in 37 of the available plans also will face a gap in coverage that will potentially force them to pay for thousands of dollars worth of medicine next year without any help.
This so-called ''doughnut hole'' can start after total drug costs (the amount the enrollee and the plan paid) reach $2,700, an increase from $2,510 this year.
After the enrollee has spent a total of $4,350 of his or her own money on prescriptions, catastrophic coverage begins and they pay 5 percent of the cost of drugs.
A dozen Medicare drug plans in Ohio will provide at least some generic medicines without a gap in coverage, but for higher monthly premiums ranging from $50.10 to $97.50.
Managed-care options
To enroll in a Medicare managed-care plan, people first must pay a premium for Medicare Part B, which helps pay for outpatient medical care.
Next year, the monthly Medicare Part B premium for most people will be $96.40.
''Many of the Medicare Advantage plans have extra benefits, such as eyeglasses, hearing exams and dental coverage, that original Medicare doesn't have,'' Lopez said. ''Some of them also have some prescription drug coverage, so that's something to look at.''
Enrollees typically must seek care at a doctor or hospital that is on the plan's list of approved providers for the bills to be covered, she said.
Those restrictions mean the plans probably aren't good options for frequent travelers or ''snowbirds'' who spend the winter in the South, Chuchanis said.
Monthly premiums for Medicare managed-care plans next year will range from $0 to $175.
But enrollees need to ''look beyond the premium,'' said Paul Precht, director of policy and communications for the Medicare Rights Center, a nonprofit advocacy group.
''There are low-premium plans, but a lot of them have hidden costs,'' such as large hospital co-pays, he said. ''Look to see if there's an annual out-of-pocket limit and if that's comprehensive.''
Select plans carefully
Medicare forbids sales representatives from going door-to-door to sell plans without an appointment.
The Area Agency on Aging's Chuchanis recommends getting advice from an independent source, such as her agency, OSHIIP or Medicare's toll-free number or Web site.
And before signing up, she said, call the plan to double-check all the coverage details and check the customer service.
Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com.
For thousands of Ohio residents who get their drug coverage through Medicare-approved plans, now's the time to start taking inventory of their medicine cabinets.
Get the full article here.
Comments
Click here to post your comments
Tallmadge, OH
Posted 08:47 AM, 11/09/2008
We can only hope the new Congress & Obama change this Medicare Part D program significantly. The costs continue to go up and the benefits down. Blue Cross & Blue Shiel;d has increased the monthly premium from $77 to $98 while raising the part you pay from $2 to $9 this year. It's gone up every year and none of the Part D programs are competitive at all. Thank you NOT President Bush & the GOP Congress for helping the big insurance and big drug companies at the expense of us retirees. The new Congress needs to change things around and soon. Retirees need the help now.
canton, oh
Posted 07:41 PM, 11/10/2008
old man grump, just what is your actual out of pocket expense and how much did you contribute during the working years? how much is the government paying for your health care now? it is understandable to cringe at increases, but as a businessman and taxpayer yet, the burden will fall on us for your increases.
