The ABCs and Ds of Medicare by Rep. Cindy Rosenwald

Falling leaves, crisp nights and pumpkins signal Halloween and Thanksgiving—a busy time of year for all of us.  These seasonal markers also mean it’s time for New Hampshire’s 230,000 Medicare enrollees to choose their health coverage plans for 2015.

The annual open enrollment period for Medicare runs from October 15 to December 7.  Although no major benefit changes are expected, and some aspects of Medicare plans are standardized, individuals do have a number of important choices to make.  Since choosing Medicare coverage options can be confusing, it’s a good idea to take the time to review costs, coverage, and network options carefully.  As long as enrollment is completed by the end of the open enrollment period, coverage for 2015 will be in place.

Medicare is an alphabet soup of coverage for hospitals and skilled nursing care, outpatient services, and prescription drug insurance.  The open enrollment period is the time when most beneficiaries will need to assess their options and needs in detail.

Medicare part A covers hospital, skilled nursing home care, some home health care and hospice.  Part B covers outpatient medical care, including doctor visits and preventive care.  For the last few years, annual physical exams and important preventive health screenings and services have been covered without cost to the patient.  Parts A and B do otherwise have cost sharing, however, in the form of deductibles, co-payments and responsibility for co-insurance, and there is no limit on the amount for which the individual can be responsible.  Some retirees have supplemental insurance from their former employers to cover the payment gap; other beneficiaries will likely want to purchase Medigap insurance.

Since 2005, Medicare Part D has offered prescription drug insurance, either through private insurance plans or some employer-based coverage.  The infamous “donut hole” is closing under the health reform law.  Last year, approximately 15,000 Medicare beneficiaries in New Hampshire were able to save an average of $800 on their medications thanks to continuing closure of this loophole.

If you are confused by this alphabet soup, you might consider choosing a Medicare Advantage plan, known as Part C, which includes parts A and B, and sometimes D. Hillsborough County residents will have a choice of eight different Medicare Advantage plans for next year.  Some plans may also cover vision and dental care.  These plans may be the easiest and most inclusive options, but they can leave the insured person with high out of pocket costs.

When evaluating their coverage options, beneficiaries need to pay careful attention to cost sharing provisions such as premiums, deductibles, co-pays and co-insurance.  It is also important to make sure your doctors and other health care providers are covered by the plan you are considering, even if they are located in a different state.  This is especially crucial for “snowbirds” and frequent travelers.

There’s a lot to consider during Medicare open enrollment.  Fortunately, help is available locally through New Hampshire’s Service Link.  Their toll-free telephone number is 1-866-634-9412.  They also have a website:  http://www.nh.gov/servicelink/medicareinfo.html.

So enjoy the glorious New England Fall.  But make your choices in Medicare as well.

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