As individuals retire or age into Medicare, their insurance situation can change dramatically. There are a multitude of options open to those with Medicare. The terms are different, the prices are different, the products offered are dramatically different each year.
The purpose of this column is to give those who are eligible for Medicare, or soon to be eligible for Medicare, some understanding of their insurance options and how it could impact their health and finances.
These questions and answers are meant as a guide to help you understand the complex questions you are now thinking about. Each individual's specific situation may create a different solution. You shouldn't necessarily do what your friends, family and neighbors do.
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Janell Sluga
Q: I received my insurance plan's changes for next year in the letter they mailed to me, but how do I know if I should switch to a new plan?
A: I receive this or a similar question each fall. We all know that each year our health insurance plan choices change. The plans change in a variety of ways; the premiums, the co-pays, the deductibles and often the types of services covered. The insurance companies evaluate costs, expenses and regulations to decide on what to cover, how much it will cost and how to cover these "projected" costs.
This year we are all seeing many changes to our insurance options. How do we know what to do - if and when to make a change?
Insurance companies were also required to notify you of these changes by Oct. 1. By that date, you should already have received a letter or document from your insurance company explaining the changes to their 2013 coverage.
For some people this year the letter says, "Your plan will no longer be available. Here are the other options we have that you may want to consider." This happens every year to some of us. In 2013 we are seeing a number of plans that have been eliminated and have had name changes.
For those with Stand-Alone Medicare Part D plans in our area, in 2012 there were 29 different plans to choose from; in 2013 there are 28 plans. The number of plans may indicate not too many changes, but there are a number of changes to the different plans. There are a few plans that are still available but have changed their names. So your letter will indicate a new name for your insurance and a new card. There are a number of plans that were eliminated and plans that are new in 2013. I believe there will be many of us who are looking for alternative coverage. There are a number of plans providing limited coverage of medications in the coverage gap (donut hole). This coverage is above and beyond the required coverage in the gap.
For those with Medicare Advantage Plans, in 2012 there were 25 plans available (17 included Part D coverage) and in 2013 there are 24 plans (17 include Part D coverage).
Once you receive your letter stating how your insurance will change, you can decide if you are interested in keeping your current plan or want to switch. If you want to switch you must do so by Dec. 7. The ways to research your options are to use the www.medicare.gov website or call 1-800-medicare. The website has a tool that allows you to enter your medications, and it will put the insurance options in financial order for you. The first plan listed being the least expensive, the last the most expensive (with regard to premiums and co-pays). Don't be fooled; there is more to it than that, but if you are comfortable using the Internet, there is helpful information on the website to get you started. If you entered your medications in previous years and wrote down your code from the website, you can enter this information and your medication list is still there.
You can also call 1-800-medicare to speak with the knowledgeable customer service representatives who will walk you through the process over the phone. The difficulty with this option is you can't see the information they are talking about, and this information can be hard to grasp if you're just listening. Remember that this customer service option (1-800-medicare) is available seven days a week, 24 hours a day. So don't try calling the middle of the business day; try at odd times, like early in the morning, middle of the night and in the evening. Your wait time will be shorter.
You can also contact Office for the Aging for help or many professionals in our region, who are well versed at helping you through this decision process. It is not easy to understand this information, and your decision can have a serious financial impact on you for the next year.
Remember to review your letter in the mail explaining what your current plan is doing. If you are comfortable with the changes, you may decide to keep your insurance just the way it is. If you had a bad experience with your current insurance, or just want to change for whatever reason, be sure to do so by Dec. 7. After that date you can only switch insurance plans if you have a Special Enrollment Period (SEP) available.
Janell Sluga is a geriatric care manager certified and works for Senior Life Matters, a program of Lutheran Senior Housing, and has worked in Chautauqua County with seniors for more than 18 years. She is HIICAP (Health Insurance Information, Counseling & Assistance Program) counselor-trained by Office for the Aging. She does not sell insurance or represent any insurance company. She is an unbiased source of insurance and education to help seniors choose the best option for them.
You may submit questions to be answered in later columns to Janell Sluga at Senior Life Matters, 737 Falconer St., Jamestown, NY 14701, or call 716-720-9797, or by email at janells@lutheran-jamestown.org.
Please remember that not all questions can be answered in this format, but as many as can be, will be.