Medicare plans open enrollment under way

Contributing columnist Lenna Scott GRID: Senior column tease pic

Updated: October 18, 2012 3:13PM

Every year there is an open enrollment window for Medicare Advantage health plans and Medicare Part D prescription drug coverage. This year, open enrollment is Oct. 15-Dec. 7.

According to the Department of Health and Human Services, “In most cases, this may be the one chance you have each year to make a change to your health and prescription drug coverage.”

That is echoed by the team at the Illinois Department of Insurance’s Senior Health Insurance Program (SHIP).

SHIP is a great resource for helping Medicare-eligible individuals understand their Medicare health benefits and select an appropriate plan for 2013. “It is prudent for people to look at their plan choices every year,” says Robin Dinardo, Assistant SHIP Program Director.

When seniors sign up for Medicare, they have two choices: Original Medicare or a Medicare Advantage Plan. The Medicare Advantage plans operate like HMOs or PPOs. They combine Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) and usually Medicare Part D (Prescription Drug coverage).

The federal Medicare agency, which oversees Medicare, says that “Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.” But, if you join a Medicare Advantage plan, you are getting your coverage from that private company, not the government. These companies follow rules set by Medicare. However, each plan may charge different out-of-pocket costs or have rules that differ from original Medicare.

During this same period, there is an option to purchase or change prescription drug coverage, “Part D.” According to materials from the Centers for Medicare and Medicaid services, there are two ways to get Medicare prescription drug coverage, through the Medicare Advantage Plans described above, or through Prescription Drug Plans. Just like Medicare Advantage, Part D plans are run by private companies, and each plan may vary in cost and coverage.

“Many of the drug plans change their formularies each year. The plan that works for you in 2012, may not be the best in 2013,” Dinardo explains,

Because they are private companies, each year these companies may change their rules as to what doctors or facilities are part of their network, or what the costs involved for care would be. The government strongly urges all participants to review their Medicare plan before the end of the open enrollment period so that users can change plans if it is necessary. Dinardo also reminds seniors that although the election period is Oct. 15-Dec. 7, changes do not take effect until Jan. 1, 2013.

It can be very complicated to evaluate different programs and determine the appropriate choices. SHIP provides free counseling either over the phone or at local sites throughout the area.

“It’s important to call and make an appointment, bring or have available a detailed list of drugs, or the drug bottles themselves, your Medicare Card, Medicare Advantage Card if (you) have it, and the current Part D card,” shares Dinardo.

SHIP staff can be reached toll-free at 1-800-548-9034, or there is a SHIP website http://insurance.Illinois.gov/SHIP. The SHIP website also has guides to help seniors compare different plans available in their area and the various costs and benefits of those choices.

In our area there are SHIP coordinators at:

• Barrington Area Council on Aging: (847) 381-5030

• Highland Park Senior Center: (847) 432-4110

• Lake Forest-Lake Bluff Senior Center: (847) 234-2209

• North Shore Senior Center in Northfield: (847)784-6036

• Patty Turner Senior Center-Deerfield: (847) 940-4010

• Wheeling Pavillion Senior Center: (847) 459-2670

Lenna Scott is the director of marketing at The Wealshire, a short-term rehab, skilled nursing and assisted living community in Lincolnshire. She lives in Buffalo Grove with her husband and two children. Contact her at lscott@wealshire.com.~.

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