As Medicare open enrollment ends, use these secrets to choose a plan

Maryalene LaPonsie | December 28, 2010

As a Medicare beneficiary, you have the opportunity each year to change your medical coverage to a variety of Medicare Advantage plans that operate as HMOs, PPOs or via other medical insurance models. Whichever Medicare plan you choose, you must act quickly. The open enrollment window is rapidly closing with beneficiaries only having until the end of the year to lock in 2011 choices.

Finding the right Medicare medical coverage

The number of Medicare plan options can be overwhelming. Chances are your mailbox has been filled in recent months with glossy brochures and envelopes filled with information about Medicare Advantage and Part D plans. While it may be tempting to send them all to the recycling bin, it pays to carefully consider your options.

According to the Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees the Medicare program, seniors should remember the 3 'Cs' when shopping for medical insurance:

  1. Cost
  2. Coverage
  3. Convenience
Beyond simply finding the cheapest health insurance, it is important to consider whether the plan meets your coverage needs and allows you to use the doctors and pharmacies you like. Many low-cost health insurance plans cut costs by restricting your choice of doctors or increasing co-insurance requirements.

Special considerations for selecting a Medicare Part D plan

For those on original Medicare, choosing a separate Part D plan is essential. Although Medicare Parts A and B provide medical insurance for hospitalizations and doctor visits, they do not provide coverage for prescription drugs. A separate Part D plan must be purchased to get critically important medication benefits.

According to an analysis by advisory services company Avalere Health, many health insurance companies offering Part D plans are now classifying medications into five tiers. The tier placement can have a significant impact on your co-payment. The pharmacy you use may also affect the co-payment amounts. Finally, some companies may require prior authorization before filling certain prescriptions

When shopping for Part D coverage, it is crucial that you not only ensure that your medications are covered by the plans, but that they also have affordable co-payment amounts. As you compare Part D plans, be sure that you learn the actual co-payment amounts for your current and expected prescriptions. Knowing your expected total out-of-pocket costs is key to determining whether the plan is really the best deal for you.

Changes everyone needs to know

With the passage of health reform, there are also some changes that all Medicare beneficiaries will want to be familiarized. These include four key changes:

  1. A one-time $250 payment to seniors paying for prescription drugs in the coverage gap, otherwise known as the 'donut hole'
  2. Fifty percent rebates on certain brand name prescriptions for those whoh are in the "donut hole"
  3. Free preventive services that don't require any co-insurance or deductible payments
  4. Free annual wellness exam

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