The Life Transition Blog

Mark your calendar!  Open enrollment season for Medicare beneficiaries has arrived.  In most cases, this will be the one chance you have to make changes to your coverage for 2014.  This year, open enrollment runs from October 15 through December 7.  Any changes you make during this time will take effect on January 1, 2014.  New costs and benefit changes, if applicable, also begin on this date if you decide to keep your existing coverage.  Don’t wait until the last moment to evaluate your options.

Every Medicare beneficiary should review their options each year.  This is because your medical status may have changed, or because the medications prescribed by your physicians may be different than they were last year.  In addition, even if nothing has changed on your side, your current health plan or prescription drug plan can decide not to participate in Medicare for the coming year, not to provide coverage in your geographic area, or to change the terms and conditions of your plan.  If you do not review your coverage, you may find that you have unexpected expenses during 2014.

There are a few global changes to Medicare for 2014.  The hated “donut hole” or “coverage gap” in Part D Rx plans is again shrinking as a result of the Affordable Care Act passed in 2010.  For 2014, the donut hole begins after you and your drug plan have spent $2,850 for covered drugs (down from $2,970 in 2013).  Whereas in 2013 you have paid 47.5% of the cost of brand-name drugs and 79% of the cost of generics while in the coverage gap, for 2013 you will pay only 47.5% and 72% respectively.  These annual reductions are scheduled to continue until 2020.   Once you have spent $4,550 out-of-pocket (down from $4,750 in 2013) you are out of the coverage gap and are in the catastrophic coverage zone where you will pay only a small coinsurance or copayment for each covered prescription.

Additional changes to Medicare for 2014 include the elimination of automatic refills for prescription drugs by mail order and a change to how co-pay amounts are calculated. In 2014, all refills must be verified by the drug plan and will only be shipped upon the patient’s approval. In addition, whereas in the past a co-pay amount for a chronic medication has been for a one month supply, in 2014 you can request a lesser supply and pay a reduced (pro-rated) co-pay. Your prescriber will have to write the prescription for less than a one month supply for it to be processed this way.

While the noted changes are positive, Medicare continues to be confusing and overwhelming to many older adults and their family caregivers.  Beneficiaries still must decide whether to subscribe to “original Medicare” (Part A and Part B) or to choose a Medicare Advantage plan (also known as Part C).  Assuming the choice is original Medicare, further decisions include whether to purchase a Medigap (a/k/a Medicare Supplement) plan or a Part D prescription drug plan, or change the one you currently have.  There can be consequences for not enrolling in such plans when you first become eligible for Medicare.   If either coverage is desired there is a further decision regarding which plan to purchase and through which insurance company.

Medicare beneficiaries can get personalized help to sort this all out by calling Medicare or visiting the website and through State Health Insurance Assistance Programs (SHIPs).  In addition, LifeBridge Solutions offers a “medical plan selection service”.  For $149 per person we will help you understand your current coverage and options that are available for your particular situation.  We do not sell insurance – only educate and advise you without regard to external incentives.  Be sure to schedule early.  Remember, open enrollment season ends on December 7.