The leaves are falling, the Halloween decorations are out and the days are getting shorter.
For millions of Americans age 65 and older, the change in seasons means it’s time to consider changing their Medicare prescription drug or managed-care plan.
Open enrollment starts Tuesday for seniors and disabled residents who rely on Medicare prescription drug or managed-care plans to help pay for their medications or medical care.
Consumers have until Dec. 7 to enroll in the optional plans or switch coverage. Changes are effective Jan. 1.
The annual Medicare open enrollment is separate from the recent launch of the Health Insurance Marketplace, created under the federal law known as Obamacare to provide uninsured Americans and small businesses a way to shop for health coverage with possible subsidies.
Francine Chuchanis, ombudsman supervisor for the Greater Akron/Canton Area Agency on Aging, has a simple message for Medicare enrollees when it comes to the new marketplace plans: “Stay away.”
“If you have Medicare, you don’t need to go to the marketplace for insurance,” she said. “The marketplace does not affect Medicare.”
Next year, the nearly 2 million Ohio residents covered by Medicare can select from among more than 30 Medicare prescription drug plans, also known as Medicare Part D plans.
Dozens of Medicare Advantage managed-care plans also are available that provide help paying for doctor visits, hospital stays and other medical services.
The Medicare Part D plans are offered statewide; the Medicare Advantage plans vary county by county.
Both types of plans are available for everyone covered by Medicare, the federal health insurance program for people 65 and older and some younger disabled Americans.
The federal government contracts with private insurance companies to provide drug and/or medical coverage to Medicare recipients who sign up for the plans. Everyone but the poorest enrollees pays a portion of the monthly premium; the government picks up the rest.
Retirees who get their coverage from a former employer or union should have received a notice indicating whether their plan is considered “creditable coverage,” or at least as good as Medicare Part D plans. 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.
Enrollees should carefully review plan details to see whether co-pays and covered drugs (known as the formulary) are changing, Chuchanis said.
They also need to make sure they can still pay the lowest co-pays at their favorite pharmacies, she said. Many plans have “preferred” pharmacies, or a tier of in-network pharmacies that offer the lowest out-of-pocket costs for consumers.
Medicare Advantage managed-care plan enrollees should check the highest amount they could pay if they use a lot of medical services, Chuchanis said. “It looks like out-of-pocket limits went up in a lot of plans.”
As many as one in four seniors don’t realize they have an opportunity each year to review and change plans if they want, according to a survey by the nonprofit health research group Kaiser Family Foundation.
In a prepared statement, Ohio Lt. Gov. and Insurance Director Mary Taylor urged consumers to work with a family member, a trusted adviser or the Ohio Senior Health Insurance Information Program to review options.
“Open enrollment is a great time to evaluate coverage, benefits and determine whether your current plan is still the right fit for you,” she said.
Consumers also can use Medicare’s 5-star quality rating system to help compare plans. The rating system considers patient experience and complaints, as well as drug pricing and patient safety for the prescription drug plans and efforts to manage chronic illnesses and promote preventive care for the managed-care plans.
Most Medicare prescription drug plans include a potential gap in coverage that could force consumers with high drug costs to pay for thousands of dollars worth of medicine on their own before more comprehensive coverage begins. However, the federal health-care reform law is slowly shrinking what is called the “doughnut hole” until it disappears in 2020.
Enrollees will get a 52.5 percent discount on brand-name drugs and 28 percent on generic drugs during the coverage gap in 2014.
Cheryl Powell can be reached at 330-996-3902 or firstname.lastname@example.org. Follow Powell on Twitter at twitter.com/abjcherylpowell.