Preparing for Age, Sickness and Death

As the story goes, a young, naive prince Siddhartha encountered “3 heavenly messengers” when he went out into the world: an elderly person, a sick person, and a corpse.  They alerted him to the inevitability of aging, sickness and transition.

Fortunately, he later he met a fourth heavenly messenger: a wise man meditating on how to face these inevitable forces.

The lesson: knowledge is power in life. Rather than succumb helplessly to aging, health problems and change, we can prepare ourselves to meet them. It is imperative that you know the choices ahead of you with regard to your health and longevity over the years ahead. Medicare is changing, and, even if you are already enrolled, each year during open enrollment, you have to make new choices about your plan choices. Now is the time to familiarize yourself with your choices.


It Pays to Shop Around

Medicare’s open-enrollment period (OEP) is October 15 through December 7, 2012. During this period, 49 million covered Americans have an opportunity to make changes to their 2013 coverage.

During the enrollment period, Medicare users select several parts of their coverage:

  • Medicare Part A and Part B for hospital stays and doctor visits.
  • Part D for prescription drugs.
  • Private plans to cover costs not paid under Medicare – either:
    • Supplemental insurance (Medigap) covering copayments and deductibles; or
    • Medicare Advantage – a comprehensive plan that incorporates all Medicare needs in a single policy (Parts A, B, D and Medigap).

Should seniors consider changing their current option? They absolutely must shop around. Some plans will have premium increases, and coverage changes could also lead to significantly higher out-of-pocket costs.

The Drug Coverage Can Give You a Real Headache

For Part D, shopping around may be particularly important this year because monthly premiums are increasing:

  • Premiums are expected to increase by 7% on average according to the Kaiser Family Foundation.
  • Some of the most popular prescription drug plans are increasing premiums by as much as 23%.
  • Others are lowering costs just 1%.
  • Some Medicare plans will no longer cover certain drugs, such as the diabetic blood sugar medicine Apidra. Paying for it out-of-pocket could cost  an additional  $200 a month.

Some Good News Too

Medicare users who fall into the coverage gap known as the “doughnut hole,” – the threshold when seniors generally have to begin paying the full cost of their medicines – have some good news. Because of the Affordable Care Act, the sweeping health care reform law passed in 2010:

  • Discounts of 52.5% on brand-name drugs (up from 50% last year)
  • Dicounts of 21% on generics (up from 14%).
  • Bigger discounts on drugs.
  • Coverage of more preventive services related to conditions such as depression, alcohol misuse and cardiovascular disease.

Some individual plans are introducing other discounts, such as cheaper prices for seniors who fill their prescriptions at specific pharmacies.

Look Out For Red Tape

Seniors may have to do more to get the best option. For example, some plans are requiring:

  • Prior authorization from a physician before certain drugs will be approved.
  • Limited quantities of covered medicines during a certain time period (each month, for example.)
  • Cheaper alternatives must be considered before more expensive drugs.

Know The OEP Options

Once the Medicare Open Enrollment Period closes on December 7, you can’t make any changes to your Medicare plan until the following year (There are some exceptions, such as if someone moves out of the area served by their plan.) During this period, covered seniors will have these options:

  • Switch from Original Medicare (Medicare Parts A and B) to a Medicare Advantage (Medicare Part C) plan.
  • Switch from a Medicare Advantage plan back to Original Medicare.
  • Switch from one Medicare Advantage plan to another. This might involve switching from a plan without Medicare Part D prescription drug coverage to one that has it, or vice-versa.
  • Make changes to the Medicare Part D prescription drug plan:
    • Join a Part D plan.
    • Switch from one Part D plan to another one.
    • Drop a Part D plan altogether.

Note: Medicare Supplement Insurance plans are an exception. They can be joined at any time during the year, not just during OEP.

How To Compare Plans

To compare the plans available in your area and estimate what your total costs would be, use free online tools like the Medicare Plan Finder. These tools will help you determine the out of pocket costs to you under various plans, such as premiums, copayments and deductibles.

People with complex health needs can hire a Medicare adviser to help them choose the right plan. Some advisory firms charge by the hour, so costs can add up for complicated cases. Flat fees can range from $75 to $400 depending on the types of plans you need to research.

Helpful Resources:

OEP preparation courses are offered by the Medicare Made Clear blog:

  • Open Enrollment Period 2013 Boot Camp is run in October and November 2012. It offers exercises to help you evaluate your current Medicare coverage that will prepare you to make decisions for OEP.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.