Annual Medicare Re-enrollment Highlights for Your Residents 65 and Older
Contact Information:
arthur moseley
813-373-0272
Full Description:
Annual Medicare Re-enrollment Highlights for Your Residents 65 and Older
November and December is Medicare re-enrollment time for our seniors. The St. Pete Times had an excellent insert on the topic in late October. Recently, we sat through an excellent summary presentation by one of the social workers at Palm Gardens ALF. Following are some highlights:
The annual enrollment period is 11/15-12/31
For first timers, they need to enroll by 12/7 in order for new plans to be effective 1/1/2010
People who are already in a plan do not need to enroll again for 2010 if they want to remain in their current plan (though they should still check for changes to their plan to ensure that they want to remain in it).
Major decisions involve:
Original Medicare vs Medicare Advantage Plans (Medicare Part C)
And, Drug Coverage (Part D)
While the Medicare Advantage programs (Part C) have some added benefits, they are not for everyone. While you can get certain benefits (like eyeglasses and health club memberships) you end up turning over a lot of the decision making to your HMO. Two areas where we have heard of challenges are Hospice (instances of clients not being approved to transfer to Hospice) and Home Health Care (instances where coverage is much less than that under the traditional Medicare plan).
As to Drug Coverage, it appears that no one plan is best for everyone. It really depends not only on the medicines but also the dosages. There is a website where you can go and put in all of your medications and dosages that will help you determine which drug plan is best for you. It is found at www.medicare.gov Things to look out for:
Step Therapies- where you have to try the drugs the plan prefers for your illness and show that they do not work before you get to use the one you are currently using
Prior Approval
Quantity limits
MAPDP- managed prescription drug plan (means you are opting for a Medicare Advantage Program (Part C)
If you don’t sign up for Part D you must show that you have coverage elsewhere or you will be penalized (for example through your previous employer, through the VA, via Medicaid, etc.)
There is a low income subsidy for which one can apply, primarily for the Drug benefit.
Resources
There are counselors in every state to provide one on one help with Medicare questions, including assistance completing the applications
SHINE is the local group that does this. It is a part of the Department of Elder Affairs. “SHINE provides educational materials and free unbiased insurance counseling to Florida elders, caregivers and family members. Our goal is to help elders understand and receive the health insurance coverage they need through Medicare, Medicaid, Prescription Assistance, Long-Term Care Planning & Insurance, and other health care issues. Please feel free to contact us if you have questions by dialing the Elder Helpline at 1-800-96-ELDER(1-800-963-5337) or email us at information@elderaffairs.org.”
1-800-633-4227 = 1-800- MEDICARE
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