Medicare enrollment a chance to refine coverage

With 53 prescription-drug plans to choose from, one could excuse older adults in the Rio Grande Valley for being mystified by the Medicare enrollment process.

Only once a year, from mid-November until Dec. 31, Medicare beneficiaries have the chance to change their health-care and prescription-drug coverage. Many insurance companies that sell prescription-drug or so-called Medicare Advantage plans modify their benefits, co-pays and premiums from year to year, so it's best to comparison shop, Medicare representatives and benefits counselors say.

"What was good this year might not be good next year," said Mary Solis, a benefits counselor for the Area Agency on Aging. "Premiums go up or down, drugs drop off the formulary ... there are many changes."

Medicare is a federal health insurance program that covers people 65 and older, some disabled people under age 65, and people with end-stage kidney disease.

Medicare beneficiaries can enroll in the original Medicare plan along with a prescription-drug plan, an HMO or PPO (also known as a Medicare Advantage plan), or additionally in a "Medigap" plan that offers additional coverage. Some people can also qualify for a low-income subsidy, which offers financial aid to people who can't afford their premiums.

Many of these plans are approved by Medicare but are run by private companies, and their costs vary widely.

Because the choices can seem overwhelming, many people just stick with one plan, said Renard Murray, acting regional administrator for the Centers for Medicare and Medicaid Services.

"They don't realize they could find significant savings by shopping and comparing plans," Murray said.

Current Medicare beneficiaries should have received in the mail a letter from their insurance company outlining any changes to coverage in 2009. CMS also sent out a booklet to beneficiaries listing all the plans available in Texas, Murray said.

Information on the various plans also is available on CMS' Web site, www.medicare.gov.

Although it's possible to read up on the plans online and make a decision yourself, counselors suggest that beneficiaries get help if the process is too confusing.

"The information can be a lot to comprehend ... they can come talk to us," Solis said. "We're not agents and don't work with any particular plan. We're not there to sign them up and make commission."

Insurance representatives frequently make presentations on Medicare Advantage and prescription-drug plans that are available in the Valley. Although CMS oversees these plans' outreach efforts more carefully now than in the past, beneficiaries should be aware that the representatives are trying to sell a particular plan and might not offer unbiased comparisons, advocates warned.

"You always want to check and make sure (which plan) is the best deal," Murray said. "Don't put all your eggs in one basket."

At a recent enrollment fair in McAllen, counselors provided beneficiaries with lists of the top five plans based on their needs, taking into account their budget, medications and health-coverage needs, Murray said.

That assistance was invaluable to Norma and Earl Holiday, Winter Texans from Michigan who attended the enrollment fair. After talking with a counselor, the Holidays decided to switch Medicare plans.

"We're both healthy, but yet we're spending quite a bit a month (on our plan)," said Norma Holiday. "So we're probably getting a new one."

How much you pay for Medicare depends on many factors, including your type of coverage, how often you go to the doctor or hospital, and whether you have other insurance coverage, the AARP says on its Web site.

Be sure and ask questions of the insurance agent or counselor when comparing different Medicare plans, advocates suggest. Consider your budget, what premiums and copays you can afford, what coverage you need, what your drugs will cost, whether you would be required to stay within a network of doctors and hospitals, and other issues.

A counselor could help you navigate this minefield, advocates said. Just be aware that it will likely take some time.

"I suggest that they be here at least an hour," Solis said. "There are a lot of choices, and the more informed they are, the better decision they'll make."

Medicare Enrollment

Types of plans available:

ä Original Medicare - A plan that covers many hospital and medical services for seniors. You can go to any doctor or provider that accepts Medicare.

ä Medicare Advantage Plans - HMOs or PPOs that are approved by Medicare but run by private companies. They include hospital, medical and often prescription-drug coverage. These plans often have provider networks, meaning you have to use certain doctors and hospitals, or else pay more. Out-of-pocket costs on these plans are often lower than with traditional Medicare.

ä Medicare Prescription Drug Plans - These plans add prescription-drug coverage to the original Medicare plan.

ä Medigap Policies - Plans that help pay some of the costs the original Medicare plan doesn't cover.

ä Low-Income Subsidy - Some people might qualify for extra assistance with their prescription drugs through the Social Security Administration.

For help during the enrollment period:

ä Call the Centers for Medicaid and Medicare Services, 800-633-4227, 24 hours a day, 7 days a week, or visit www.medicare.gov.

ä Call the Area Agency on Aging at 800-365-3481.