Since its rocky beginning in 1966, Medicare has become the main health insurance provider to more than 50 million Americans, most of them Seniors over age 65.  However, the program has become intensely complex, resulting in a maze of information, plans, and pitfalls that can often derail an individual’s healthcare.  Many individuals just give up trying to determine the best coverage and accept whatever is presented by just any insurance agent, regardless of whether the coverage is the “best fit” for the individual’s needs.

While Medicare is intensely confusing at times, the basic plan is simple:

Part A is hospital coverage, Part B is medical coverage, Part D is prescription drug coverage, and Part C (Advantage) is usually a combination of Parts A, B and D.  Beyond that, with the addition of supplements, the confusion really begins.  Randolph County will have 24 Part D Prescription Drug Plans (PDP’s) and 16 Part C Advantage plans for 2018.  There are over 300 potential Medicare Supplement and Advantage plans available in the State of North Carolina.

With Original Medicare, there is no network so individuals have more choices for doctors and hospitals.  Most Advantage plan models use either a Health Maintenance Organization (HMO), with a limited network of doctors and facilities, or a Preferred Provider Organization (PPO), allowing individuals to go outside the network but with higher costs.  Under original Medicare, you don’t have to worry about your plan shutting down or leaving the area.    Medicare Advantage plans offer “one-stop shopping” with no need to purchase a separate drug or supplemental policy.  Advantage plans typically have lower cost sharing than original Medicare.

Medicare changes are announced each fall. The Annual Enrollment Period (AEP) is October 15 to December 7, with plan changes effective January 1.  Medicare recipients should have already received their Annual Notice of Change (ANOC) about their current plan changes for 2018.  Medicare eligible individuals should carefully review the ANOC to determine what may change for the next year, and if their current plan still meets their health insurance needs.  The Medicare AEP provides an opportunity to change plans for more effective coverage.  Unless a plan is leaving the area, or an individual chooses to change plans, enrollment will automatically rollover for the new year.

The Medicare Advantage and Prescription drug plans can change a lot from year to year resulting in higher premiums, changed deductibles and co-pays, and non-formulary medications.  Failing to evaluate your current plan and find the right plan fit for you could cost hundreds and even thousands of dollars more each year.  But the decision isn’t just financial; your health care needs and preferences often evolve as you age.  As your needs change, you might be better off with different coverage.  However, only 20% of individuals change their Advantage plan and 12% change their prescription drug coverage according to a 2016 Kaiser Foundation analysis.  The complex choices are often the reason individuals fail to change.  Every individual should review their plan each year to be sure they have the most effective and affordable coverage.

In considering Part D or Medicare Advantage plans, individuals should understand WHAT they are buying.  Advantage plans, while considered a part of Medicare (Part C), operate differently than traditional Medicare and supplements.  Many of these plans are being marketed as “the same benefits as Medicare” or “replacement Medicare” without the premium required for supplements.  While technically true in the sense these plans provide hospital, doctor, and nursing home coverages, the manner in which the payments are made differs greatly from both Original Medicare and individual Advantage plans offered by various private insurance companies.

Medicare enrollees should verify their current plan is still effective and will meet their anticipated needs in 2018.  Individuals are responsible for determining if their provider is in the network, if any.  Not all plans are accepted by all providers.   This puts many consumers at risk of having to change doctors, or having non-covered services if their provider is not in network.  Individuals should understand plan benefits and limitations BEFORE enrolling or changing plans.  Generally, enrollment in Part D plans and Advantage plans is for an entire calendar year, January 1 to December 31.

Assistance in determining appropriate plans is available through a NC licensed insurance agent or the North Carolina Department of Insurance Seniors Health Insurance Information Program (SHIIP).  SHIIP Counselors are available Monday through Thursday at the Weinberg Randolph County Senior Center located at 347 W. Salisbury Street in Asheboro.  The phone number is 336-625-3389.  Information is also available on the SHIIP website, as well as the Official Medicare website, WWW.MEDICARE.GOV

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