Medicare Part D Open Enrollment Ends December 7
Navigating through the Medicare Part D prescription drug coverage can be confusing and choosing the wrong plan can be a costly mistake with high out of pocket expenses. So, how do you find the right option? Where do you turn if you simply don’t know where to start?
The Michigan Medicare/Medicaid Assistance Program (MMAP) is a statewide program run by a team of volunteers that have gone through an extensive training on Medicare and Medicaid. MMAP can help individuals determine which plans cover their medications and narrow down their options to see what will work best for them. The decision on which plan to choose is still made by the individual, but they are armed with the information they need to make the decision.
“The options can be a lot to sort through, especially if you are taking multiple medications and need to search for plans that cover specific prescriptions,” says Karen Rozelle, Regional MMAP Coordinator at the Area Agency on Aging of Western Michigan. “So much of the research into which plan is right for you is completed online now, which can be intimidating to some older adults. Our volunteers are trained in how to use the system and they are ready to help.”
This year there are 34 available drug plans in Michigan. Some of the plans that were popular in West Michigan in 2012 have been discontinued for 2013 while other ones have changed portions of the coverage. Experts advise beneficiaries to review their plan each year to make sure it still works for their current needs.
“Plans can change from year to year and if you don’t do the research, you may end up with surprises that are very costly. By doing the research, you can determine if that plan still fits your needs,” says Rozelle. “It’s also possible that someone’s health and /or their health care needs have changed during the year and they will want to take that into consideration. For example, are they going to the doctor more often or are they taking more medications now than before. All of these need to be considered in order to make the most cost effective choice.”
To contact a MMAP counselor in your area, call 1-800-803-7174. To search plans online go to www.medicare.gov
Medicare Donut Hole Gets Smaller
Changes are coming for those with Medicare Part D Prescription Drug coverage. These revisions, brought about by the Affordable Care Act (ACA), include reductions in the donut hole which will cut back on costly medication expenses. The new adjustments will take effect in 2011, but decisions on coverage have to be made between November 15 and December 31.
The Part D coverage gap (donut hole) is like a second deductible in the middle of the year for those with high prescription drug costs. In 2011 individuals will reach the coverage gap after the full costs of their prescriptions for the year reaches $2,840.
In the past, once that amount was reached, individuals would be required to pay the full cost for their prescriptions until they reached the catastrophic level of coverage. In 2011 (because of the ACA changes) beneficiaries who reach the coverage gap will only pay 93% of the cost for their generic medications and 50% for their brand name drugs. Each year this coverage gap will be reduced until it is completely eliminated in 2020.
“These reductions will significantly lower beneficiary’s out-of-pocket expenses,” says Karen Rozelle, Regional Michigan Medicare/Medicaid Assistance Program (MMAP) Coordinator at the Area Agency on Aging of Western Michigan. “There still are costs for the Part D Drug plans and when comparing options, individuals need to factor in medications, co-payments, premiums and other out of pocket expenses.”
MMAP is a free program that utilizes trained volunteers to counsel Medicare beneficiaries and their families with Medicare and/or Medicaid questions. They also provide assistance with the Part D drug program process.
This year there are 35 stand-alone prescription drug plans to choose from for
“Selecting a Medicare Part D prescription drug plan can be an overwhelming process,” says Rozelle. “We encourage seniors to make their health care coverage decisions based on all the facts. Choosing a plan that does not offer the best coverage for their needs can be very costly.”
Once an individual has enrolled in a prescription drug plan, they are under that plan’s guidelines for an entire year, so this is not a choice that should be made lightly. Rozelle recommends consulting a MMAP counselor, who is trained on what to look for and how to help individuals navigate the Medicare Prescription Drug program.
Medicare beneficiaries must consider all the medications they are currently taking. “Each plan provides different prescription coverage and it is important to include all prescriptions to ensure they are covered under the Part D plan. Not factoring in all of their medications could be a costly mistake,” says Rozelle.
Rozelle recommend reviewing your drug plan each year to see if there have been changes. “It never hurts to be informed,” she states. “Taking precautions to ensure you have the coverage you need may help prevent problems or surprises during the year.”
The ACA also includes coverage for preventative services and some new benefits to Medicare beneficiaries in 2011 like annual free wellness exams.
MMAP operates statewide so, individuals can call 1-800-803-7174 from anywhere in
For assistance, or to set up an appointment, call MMAP at 1-800-803-7174.