Time seniors must decide on Medicare
BY TERRY SAVAGE Sun-Times Columnist Nov 19, 2009
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
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
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.
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
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
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
Terry Savage is a registered investment adviser. Distributed by Creators Syndicate.