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Medicare plan changes are coming; seniors should review coverage

About 13% of Medicare Advantage plans are being phased out, forcing those who have them to make new choices. Even for those not losing a plan, there are good reasons to evaluate coverage now, during open enrollment.

November 21, 2010|Kathy M. Kristof | Personal Finance

Nobody likes to deal with their medical plan choices — possibly least of all seniors.

About 80% of older Americans remain in whatever Medicare plan they started with, even when unhappy with the care, according to a recent survey by Allsup, an Illinois-based Social Security and Medicare consulting firm.

This year, 3.5 million seniors won't have the option of just keeping the status quo. About 13% of Medicare Advantage plans are being phased out, forcing those who have them to make new choices.

But even if you're a senior not losing your Advantage plan, experts say there are good reasons to evaluate your coverage during Medicare's open enrollment period, which started last week and continues to the end of December.

"Medicare plans change more year to year than you might imagine," said Ross Blair, chief executive of PlanPrescriber, which provides online tools for Medicare beneficiaries to select plans. "Your health can also change fairly dramatically. That could mean that the plan that was great last year isn't a good choice now."

Moreover, in past years, seniors who decided they didn't like the health choice they'd made (or didn't make) during open enrollment were allowed to shift into a similar type of plan during the first months of the following year. But that option is being eliminated, said Paul Gada, personal financial planning director for Allsup. Starting next year, the ability to switch plans is far more restricted.

That could make it costly to procrastinate. You know you need to shop for a new plan if yours has been closed or merged, but you should also consider shopping if your health has changed significantly or if your plan has made changes to coverage, Gada said.

How would you know whether your plan has made changes? Take a close look at the annual "Notice of Change" that landed in your mailbox this month, Blair suggested. It spells out any significant shifts in your coverage, including premiums, co-payments and deductibles.

Don't assume the plan hasn't changed just because the premiums and co-payments are stable, he said. Make sure the plan hasn't changed the drugs it covers too.

If you take medications regularly, those changes can be pivotal, Blair said. If your plan stops covering your prescriptions — or shifts to covering only generic drugs and you're set on a name-brand medication — it can cost you a small fortune. Yet a change in drug coverage doesn't jump out at you like a change in premiums, co-payments or deductibles.

If a quick review of your plan indicates you need to shop, there are some online tools that can make the process relatively easy.

Medicare.gov offers a "Compare Drug and Health Plans" widget on its website, which allows you to plug in your ZIP Code and prescriptions to get a listing of the plans available in your area. This listing includes premiums, co-payments and whether the plans cover the medications that you plugged into the list.

The downside to the Medicare.gov feature? It can be overwhelming. I plugged in a ZIP Code and sample set of seven common medications, and the website found more than 60 plans to choose from. These included traditional Medicare plans, traditional plans plus prescription drug coverage, and so-called Medicare Advantage plans. The site said that out-of-pocket costs for the choices would range from $1,900 to $9,200 — an incredibly wide margin.

A somewhat simpler option is provided at http://www.planpresciber.com, which seems to use many of the nifty aspects of the Medicare widget. It also adds features of its own, such as allowing you to filter a search so that you can, for example, limit the results only to traditional plans or Medicare Advantage plans. You also can click on the plan you currently have and the site will show you other plans that are less expensive.

Of course, costs are not the only issue. If you have chronic health problems or expect to need specific medical procedures, it might make sense to do an even more thorough review to see which plans specialize in the type of medicine you're likely to need, Gada said.

Those who want individual help choosing a plan can use Allsup's Medicare Advisor service. But unlike the websites, it's not free. The Belleville, Ill., company offers a tiered fee structure that ranges from $75 for those just needing help choosing a prescription drug plan to $350 for those needing help throughout the selection process.

Whether you shop online or shop with a paid advisor, the wise thing is to at least shop, experts said.

"Not doing anything is a choice, and it might not be the best choice," Gada said.

business@latimes.com

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