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Time seniors must decide on Medicare

Updated: May 3, 2013 12:15PM



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

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!

Medicare HMO

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.

Part D: prescription drugs

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.

Finding the best Part D

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.



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