• August 27, 2014

It’s that time of year again: Open enrollment for Medicare

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Posted: Friday, November 2, 2012 4:30 am

This is the time of year that often has senior adults a bit “on edge.”

Grandsons are playing football and getting hurt. The holiday season is coming and the savings may get hurt. Cold weather is on the way and utility bills could hurt the pocket book.

But the biggest stressor during this time of year is Medicare open enrollment for seniors over the age of 65. Big choices have to be made if a change is desired in a senior’s Medicare coverage.

The Area Agency on Aging, a partner agency of the Central Texas Aging and Disability Resource Center, will hold a Medicare Information Seminar at the Harker Heights Library/Activity Center at 9 a.m. Nov. 19. Individual counseling will be available after the presentation until noon. Advance registration for the seminar and counseling session is requested and may be done at the Harker Heights Recreation Center.

Through Dec. 7, senior adults need to review their Medicare plan and decide if they will keep the arrangements for the coming year. Decisions must be made and finalized by Dec. 7. No changes may be made after that date except in a few special situations.

New plans go into effect on Jan. 1. If you stay with the same plan, any changes by the provider, such as costs, coverage or benefits, will also go into effect on Jan. 1.

The “Medicare & You” handbook should have arrived in your mailbox in early October. If it did not, call Medicare at (800) 633-4227. The information you need to make an informed decision is in the handbook. You may be able to find a plan that costs less, covers more of your medications and allows you to go to the providers you prefer, such as a specific physician or pharmacy.

During Open Enrollment, you can decide whether to stay in Original Medicare or join a Medicare Advantage Plan. You can use open enrollment to switch back to Original Medicare if you choose.

In addition to the “Medicare & You” handbook, you may also get help at www.medicare.gov/find-a-plan or by calling the Medicare number listed above. The handbook has the plans for this specific region of the state. You can get personalized health insurance counseling by attending the seminar on Nov. 19 or by calling Medicare.

To briefly summarize Medicare, there are multiple parts to the system.

Part A partially covers inpatient hospital visits, skilled nursing facilities, hospice service and home health care assistance.

Part B helps cover physician services, outpatient care and some preventive services, such as mammograms or counseling for depression.

Part C is the Medicare Advantage section. It offers plans run by Medicare-approved private insurers as alternatives to the Original Medicare. Most cover prescription drugs and other extra benefits.

Part D is the prescription drug coverage. It is optional and carries a monthly premium. There are, of course, deductibles and co-payments with all parts.

In addition to the basic parts, some senior adults have Medigap or Medicare Supplemental insurance offered by private insurers. These plans help cover the expenses Medicare does not pay.

Some changes will take place in 2013. Additional preventive and special screening services will be covered. “Donut hole” gap coverage will increase to 52.5 percent on brand-name drugs and 21 percent on generics.

There will be a newly redesigned Medicare Summary Notice, which explains what your provider billed for your visit, what Medicare approved and what Medicare paid. It will also tell you how much you must pay. The website (www.medicare.gov) has been recently reworked and has simplified language and ease of navigation. Especially nice is a quick link to replace a lost Medicare card or find Part C and Part D plans in your area.

If you are a senior adult, the time to make a change is now. Consider all the parts of Medicare that apply to you, attend the seminar and see if a change in plans would be helpful. If you have Tricare for Life, you do not need to pick up a Part D insurer. Tricare covers your prescription needs but some local seniors feel a Medigap plan is important. The Medicare Seminar on Nov. 19 will answer these questions.

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