Time seniors must decide on Medicare

Every year seniors are faced with the tough task of making decisions about their Medicare coverage — both for their basic healthcare coverage and for the Part D prescription program.

Now it’s time to start the process again. Now through Dec. 31 is the “open enrollment” period that lets seniors once again choose the type of coverage that is least expensive, given their personal situation.

Even seniors who are very happy with their current plans must go through this process. That’s because the providers can change the coverage they offer for various services and drugs — and they can change the prices they charge for those drugs.

Here are the basic choices:

Traditional Medicare is available at age 65, even if you don’t qualify for Social Security until age 67, but you must enroll to gain coverage.

Traditional Medicare comes in two parts:

Part A covers hospitalizations, and some skilled nursing care at an in-patient facility. While there is no cost for Part A, there is still a 20 percent co-payment required for most services.

Part B of Medicare helps pay for doctors, outpatient hospital care, ambulance transportation, and a variety of other tests and services. Part B pays 80 percent of most covered services, leaving you responsible for the balance. The premium for Part B depends on your income in the previous year — and can be as high as $300 per month.

Since both Part A and Part B require you to pay a significant deductible, most people also purchase a Medicare supplement to cover those costs. That could add another few hundred dollars a month to your senior health insurance costs!

But there is another choice. You can enroll in a Medicare HMO, which covers all charges in one monthly fee — including prescription drugs. The catch is that you must use physicians and hospitals in the network, which may preclude you from seeking care from a specialist of your choice. Still, these programs typically cost less than the traditional Medicare, so you should investigate the options. Depending on your situation, coverage may start around $275 a month, but be far more expensive if you are older or in poor health.

There is a link on the home page at http://www.Medicare.gov that allows you to compare Medicare HMO health plans in your area.

Unless you are enrolled in a Medicare HMO, or still have prescription drug coverage from your employer’s health plan, or are a veteran and use only drugs covered by the VA (a limited list), you must enroll in Medicare Part D — the prescription drug program.

Important: Even if you enrolled last year and are perfectly happy with your coverage, you have to START OVER now! That’s because many plans are changing their costs, eliminating coverage for some drugs, raising prices on others, and restructuring so they do not offer coverage for the “donut hole” period in which seniors must pay all drug costs.

According to the Medicare Rights Center, an advocacy group:

• Average premiums will rise from $35 to nearly $39 per month.

• More plans will charge a deductible in 2010.

• Fewer plans will offer coverage in the “donut hole.”

• Plans that do offer coverage in this gap period often charge more for generic drugs during this time period.

• Low-income seniors especially need to review their coverage or they may face an additional $10 premium next year.

Fortunately, the government has created a “plan-finder” tool at Medicare.gov. Or you can contact them by phone at 1-800-MEDICARE. But you must be prepared to go through this process. At www.Medicare

.gov you’ll see a blue box in the center of the page, with the headline Health and Drug Plans. Click on the second option: Compare Drug Plans.

Then click on “personalized search” — which will require you to input your Medicare number. That will let you find the plan that offers the least expensive coverage for your meds.

Line up all your prescription drug bottles in front of you. Make sure the label lists both the name and the dosage. Once you get started the process is pretty easy, since the computer does all the work for you. Just go through the program step-by-step. Be very careful to insert the correct names and dosages of all drugs you are taking.

You’ll have a chance to choose a convenient pharmacy or mail order coverage. Then you’ll be presented with a list of plans, starting with the lowest cost. Only the computer can do the complicated calculations because the insurers had to provide their costs for each covered medicine as well as their deductibles.

You can click on a few plans to compare — and even click a direct link to the plans so you can get the enrollment information you need. If you need additional medicines during the year and they are not covered by your plan, it is possible for you and your physician to request coverage.

Terry Savage is a registered investment adviser. Distributed by Creators Syndicate.