Medicare recipients, review your coverage to save money

With all the publicity about enrolling people in Obamacare, it’s easy to forget that enrollment is also underway for an entirely separate governmental health program: Medicare.

Every year, the nation’s 50 million Medicare beneficiaries have a chance to change their coverage during an enrollment period. It started last week and runs through Dec. 7.

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FOR THE RECORD: A previous version of this article gave an incorrect web address for information on the Health Insurance Counseling and Advocacy Program.

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The options for Medicare Advantage and prescription drug plans are many. That’s why television viewers and many mailboxes are being bombarded at this time of year with pitches for Medicare plans.

Experts urge seniors to review and compare plans every year, even if they’re happy with their current coverage.

“These plans do change dramatically year over year,” says Ross Blair, senior vice president of eHealthMedicare.com, which provides tools and information on Medicare insurance issues. “Most people are in the wrong plan, and few take time to look at their options.”

Consumers sometimes pay too much. An eHealthMedicare.com survey of more than 11,000 people found that just a small fraction are enrolled in the plan with the lowest total out-of-pocket costs. Seniors spend on average over $600 more per year on their medications than is necessary, the company found.

Though it’s a good idea to shop around, the process can be daunting.

“My rates went up,” says Pauline Soriani, a 91-year old retiree in New Port Richey, Fla. “A lot of benefits have been decreased. I don’t know if I’m better off staying where I am or changing plans.”

Here are recommendations when shopping for Medicare Advantage and Part D plans.

• Avoid Obamacare exchanges. To start, seniors should not confuse the Medicare seven-week open enrollment period with open enrollment under the Affordable Care Act.

Many people mistakenly think they can buy Medicare Advantage coverage and Part D prescription drug plans through Covered California, the state’s health insurance marketplace. But they can’t, says Elaine Wong Eakin, executive director of the Medicare advocacy organization California Health Advocates.

The matter is complicated by the fact that Covered California allows seniors to go through the application process even after indicating they are 65 or older. “We were hoping something would pop up to talk about Medicare,” Wong Eakin says.

Medicare beneficiaries looking to shop their coverage options should head to the Medicare plan finder at medicare.gov.

• Medicare Advantage. These plans provide Medicare Parts A and B benefits through a private health insurer. They generally carry an additional monthly charge beyond basic Medicare coverage, but many come with no premium at all.

These plans cover hospitalization, outpatient care and, often, prescription-drug coverage under one plan. There are 359 such plans in California for 2014, not all available statewide.

The average Medicare Advantage premium for next year is expected to be $32.60 a month, or $1.64 higher than last year, according to the U.S. Department of Health and Human Services. But premiums vary widely from one plan to another. So do other out-of-pocket costs.

“Averages get confusing,” Blair says. “If you drill down, what you find with Medicare Advantage is that plans try to hold on to zero premiums while increasing deductibles, co-pays and coinsurance. So it’s important for people to read the fine print.”

It’s also a good idea to make sure that the plan covers the doctors and hospitals you want.

James Grove, a 74-year-old retired firefighter in Agoura Hills, has had the same Medicare Advantage plan for years, and he says he’s reasonably happy with it. “The only bad thing is if we’ve got to go to a hospital, it’s farther than we want to drive,” he says. “We’re getting older, and it’s a long way to go.”

Grove is willing to take the drive if he has to, but that may not work for everyone.

• Prescription drug plans. Part D plans, which are optional and you pay extra to join, cover the cost of prescription drugs that basic Medicare alone does not.

Nationwide, there are 35 stand-alone Part D drug plans, according to an analysis by the nonprofit Kaiser Family Foundation. In California, beneficiaries can select from 31 plans.

The average monthly premium for Part D drug coverage in 2014 will be $31, according to estimates from the federal government, but there’s wide variation in costs. In California, 14 plans are raising their premiums, Wong Eakin says.

As with Medicare Advantage plans, premiums alone won’t tell the full story of how much you’re likely to spend over a year.

Be sure to evaluate out-of-pocket costs, such as deductibles, co-pays and coinsurance. A plan may also have restrictions, such as filling prescriptions at in-network pharmacies, getting prior authorizations or requiring a patient to try generic drugs before a brand name.

“It makes sense to take time to see how the plan is changing and if changes in the coming year might affect someone’s ability to access medications,” says Juliette Cubanski, associate director of the Kaiser Family Foundation’s Program on Medicare Policy.

• Read the stars. Quality medical care makes a difference. Medicare created a quality rating system to help consumers compare plans. A plan can receive one to five stars, with five being the best, based on the agency’s assessment of medical services and customer satisfaction.

“Efforts to increase quality have been paying off. There will be more four-star Medicare Advantage plans next year,” says Matt Eyles, executive vice president at consulting firm Avalere Health.

Experts say it’s a good idea to use the numbers to guide your choices. “A plan with less than 3.5 stars is a red flag,” eHealthMedicare.com’s Blair says.

Resources and links

To review your plan options: Medicare plan finder at https://www.medicare.gov or call (800) MEDICARE, or (800) 633-4227; eHealthMedicare.com.

For free personalized counseling services: Health Insurance Counseling & Advocacy Program, cahealthadvocates.org/HICAP/index.html, or call (800) 677-1116; Medicare Rights Center’s toll-free help line, (800) 333-4114. Counselors are available Monday through Friday.

For information about Medicare benefits: Medicare Interactive, https://www.medicareinteractive.org

healthcare@latimes.com

Zamosky writes about healthcare and health insurance. She is also the author of a new book, “Healthcare, Insurance and You: The Savvy Consumer’s Guide.”