Medicare Coverage Changes Every Year!

Provided by Oregon SHIBA Program. They can be reached at 1-800-722-4134.

Medicare coverage changes every year. How can a person with Medicare keep up with it all? This article provides tips on how to make the most of your Medicare coverage.

First: what kind of coverage do you have? Is it from work? Is it a public benefit (Oregon Health Plan)? Is it from a private company? Pull out your insurance cards and look at them. Focus on what is happening to the insurance you have right now (unless you plan to compare and change plans).

Here is a schedule of what to look for.

October: Save the Mail! Before October 31st, Medicare Advantage and Part D plans must send written notice of the changes they will make to your coverage. This Annual Notice of Change shows whether the drugs you take are still covered, whether your doctor is covered, and whether certain costs (such as co pays for lab work, x-rays or dialysis) will change. Some insurance plans may send next year's insurance cards in this mailing. Reading this information carefully in October can help you avoid unpleasant surprises in January, when the new plans take effect. Be careful not to mistake this mailing for advertisements for other plans - many people throw everything away in frustration. Get a shopping bag if you have to, but save your October mail about Medicare, and sort it carefully.

Plans that are ending their service in Oregon must also send you a written notice. It will contain complete instructions about what your rights are, and what you need to do to get new coverage.

November 15th - December 31st: The Fall Annual Enrollment Period. You can add, drop, or switch Part C (Medicare Advantage) plans, and/or Part D (Drug Coverage) plans. You can also decide to stay with the plan you have because it works best for you. You are not required to change plans unless you got a written notice that your plan is ending its service in Oregon.

Because these plans change each year, it is important to compare plans to see if one may serve you better by looking at Cost, Coverage and Convenience.

Cost: What is the monthly premium cost? What deductibles must you meet before the plan starts paying? How well does it cover the drugs you take, and how much do you have to pay? What co pays are you responsible to pay for hospital, lab work, doctor visits?

Coverage: Does this plan cover your preferred doctors and hospitals? What health care services do you use most? Do you need home oxygen? Do you have regular blood tests? Will you need surgery this year? Are you very healthy but want to have your blood pressure checked? How well does the plan cover these services?

For drugs, are there expensive drugs without generic equivalents that you must take? Check to see how well they are covered. Does the plan's "formulary" (list of covered drugs) match well with your needs?

Convenience: Does your current pharmacy (or one near you) accept this plan? Is there a mail-order option to receive a 90-day supply of drugs by mail?

How do you compare these things? Grab a list of your current medications, your red-white-and-blue Medicare card, and any other health insurance cards you have, go to www.medicare.gov, and click, "compare plans". If you do not own a computer, is there one at a family member's house, a library or senior center you can use?

Important: You must be enrolled in Part D (drug coverage) by December 31st.

January 1 - March 31: Medicare Advantage "Open Enrollment Period".

During these three months, you can change your Medicare Advantage plan to get equivalent coverage from a different plan. As long as you already enrolled in Part D before December 31st, you may also be able to change drug coverage. This period can be very useful for people who find that their current coverage is inadequate, or a new plan might work better for them.
Also in January through March is the Medicare General Enrollment Period. People who are late in signing up for Original Medicare (Part A or Part B) can sign up now, so their coverage will take effect in July.

Medicare can be confusing. If you're not sure how to proceed, there is help!

SHIBA (Senior Health Insurance Benefits Assistance) has well-trained volunteers who can help you to compare health plans. This help is unbiased, free of charge, and available in your local area. In Marion, Polk and Yamhill Counties, you can reach the SHIBA program by calling 1-800-469-8772. For assistance in other areas of Oregon, the state SHIBA Hotline is 1-800-722-4134. In addition, 1-800-MEDICARE (633-4227) is open 24 hours a day, 363 days per year.

It's your Medicare. Don't give up. You can find affordable coverage that works for you.

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