The open enrollment period for 2013 Medicare plans begins October 15
and extends through December 7. This annual ritual asks more than 50
million people, mostly seniors, to venture forth once again into the
arcane and complex world of Medicare health insurance—Parts A, B, C, and
D, drug formularies, shifting co-pay, coinsurance, and deductible
rules, and now, a growing assortment of health reform changes.
Is it any wonder that many seniors shudder at the prospect of
actively shopping for new Medicare insurance providers? Instead, they
tend to stick with their current insurance plans, while experts and
pundits (like me) lament how much money they could be saving if only
they shopped around like they do for most other consumer purchases.
"Not a lot of people are switching plans," observes Mary Dale
Walters, senior vice president for Allsup Medicare Advisor. Allsup
provides fee-based Medicare coverage advice to consumers, and does a
lot of its business with disabled people. The bad news about Medicare's
complexity has been good news for Allsup, which reports that its
advice business has been growing steadily.
Medicare consumers "ride out the price increases," Walters adds.
"They don't do the math. They are worried that their doctors won't be
covered under a new plan ... People bog down in indecision because
they're scared they are going to make a mistake." While many things
change about Medicare each year, Walters says, "the only thing that
doesn't change under Medicare is that it continues to be complicated."
Avalere Health, a Washington D.C., healthcare research firm and
consultancy, has looked at 2013 Medicare plans and found that seven of
the 10 most popular plans were raising their drug prices by more than
10 percent. Dan Mendelson, president of Avalere, says it's particularly
important for consumers to look at the prices of their prescription
drugs, including co-pays, and see if it makes sense to switch plans.
In addition, he adds, more health plans are developing partnerships
with preferred pharmacies. "You get your drugs more inexpensively if
you purchase them from a preferred provider," Mendelson says. This is
yet another reason consumers should look at the drugs they take and
compare prices from other health plans.
Health reform changes will reduce the price of drugs for seniors
with big drug bills who fall into what's called the doughnut hole. Once
drug expenses hit $2.970 in 2013, insurance coverage ceases until a
person's out-of-pocket expenses reach $4,750. The health reform law has
been lowering the cost of drugs inside the doughnut hole. For 2013,
consumers must pay 52.5 percent of the cost of branded drugs and 79
percent of the cost of generic drugs. These percentages will decline in
future years under the law.
While the open enrollment period ends in December, Walters notes
that this restriction does not apply to plans that have received top
marks under the government's relatively new rating system. Plans with a
5-star rating may enroll consumers at any time during the year.
Because of the newness of the program, there were few 5-star plans for
2012 enrollments. But the number is expected to increase.
Overall, Mendelson and Walters agree, premiums for fee-for-service
Medicare (parts A and B) should not rise much in 2013, and premiums for
managed care Medicare Advantage plans (part C) should change very
little.
"The general feeling is that there is not going to be major
increases in premiums," Walters says. "If your premiums aren't changing
much, make sure your co-pays aren't changing much, either."
"It's reasonable to expect that the part B premiums (for physician
and outpatient services) will be going up in the range of 5 to 10
percent next year," Mendelson says. Medicare is expected to announce
part B costs for 2013 soon, but a spokeswoman declined to specify a
date.
Both experts advised consumers with traditional fee-for-service
Medicare plans to take a careful look at Medicare Advantage (MA) plans.
"The care coordination is often better and the prices are often much
more stable," Mendelson says. "People don't have to worry as much about
out-of-pocket costs. MA plans structure their premiums differently and
you're generally not paying a 20 percent co-pay on physician
services." Accepting restrictions on the choice of physicians may be
unacceptable for some traditional Medicare users, he notes.
Walters advises people to have their own plan for healthcare
services before they begin looking at the plans for the 2013 enrollment
process. "You really need to begin with a needs assessment," she says.
"Focus on those things that you have already identified as being
important to you."
This list usually contains specific prescription drugs but should
also include expected medical visits for routine care as well as care
for any ongoing illnesses or health needs. Do you need regular blood
work and other laboratory services? Are there predictable surgeries?
Have you factored in the expanding range of free preventive health
services under the health reform law?
Once you've developed your needs list, Walters says, it's much
easier to use the Medicare website or specific insurer sites "without
being overwhelmed by all the options" that are available.
Source http://money.usnews.com/money/blogs/the-best-life/2012/10/09/medicare-open-enrollment-tips-for-2013
