Many Medicare beneficiaries can improve their health coverage by taking action during Medicare’s annual enrollment period. In 2010, this period began November 15th and will end December 31st. During this period, you may add or change prescription drug coverage, or add/change a Medicare substitute called a Medicare Advantage Plan.
Medicare prescription drug plans are called Part D and were first added to original Medicare in 2006. Part D is an additional but optional benefit to original Medicare parts A (hospital) and B (medical). Medicare Advantage plans are called Part C and are also optional. Part C plans replace original Medicare parts A and B for all Medicare covered health services except Hospice care. Most Advantage plans also provide Part D, and some also offer dental, vision, hearing, fitness and other coverage not included in original Medicare.
Most Chicagoland beneficiaries (Cook, DuPage, Kane, Lake and Will counties) can choose from 30 drug plans, 10 Advantage plans with drug coverage and 3 Advantage plans with no drug coverage. Stand-alone drug plan monthly premiums range from $0 to $60, coinsurance ranges from 25 to 35%, and deductibles, your out of pocket cost before any plan begins paying its share, range from $0 to $310 annually.
Monthly premiums for Chicago area Advantage plans range from $0 to $121 for standard coverage. Vision, hearing, fitness and/or dental coverage generally cost an additional $19 to $40. Interestingly, Drug coinsurance and overall deductible amounts are in the same range as stand-alone drug plans.
Copayments for medical services, facilities and suppliers vary by plan. Expect to pay $5 to $20 for your primary doctor visits and $30 to $40 for specialists. Other copays and coinsurance amounts are generally lower than original Medicare and unlike Medicare, most plans feature an annual out of pocket maximum of $3100 to $6,700. That’s why they are called ‘Advantage’ plans.
Bear in mind, however, you must continue to pay your part B premium as usual even if you join an Advantage plan even though you will not be using your Medicare coverage while you’re enrolled – except for Hospice care. Medicare passes on a portion of this premium to these plans. That’s why their premiums are typically lower than supplemental plans.
Drug plans may require you to use network pharmacies except in an emergency, but most Chicagoland pharmacies strive to participate in as many networks as possible. Advantage plans generally require you to use a local network of participating facilities, suppliers, pharmacies, doctors and other providers. Network sizes range from about a thousand to twenty thousand. Some plans allow you to choose your primary doctor at no extra charge and use out of network specialists for an additional copay.
Snowbirds and those who may travel outside of Chicagoland should discuss their coverage needs with any plan they are considering before enrolling. These network and area-specific issues constrain some beneficiaries to choose original Medicare with or without a supplemental plan.
Call 1-800-MEDICARE (1-800-633-4227) and/or visit www.mymedicare.gov to find out more.