Medicare’s open enrollment comes early this year, Oct. 15, and lasts longer, until Dec. 7. But that doesn’t mean one can wait to compare plans and decide which one fits best.
Centennial Hills Hospital Medical Center, 6900 N. Durango Drive, held a seminar Sept. 19 where about three dozen seniors gathered to learn about the different programs.
Diane Kurdirka was at the session. Because she recently turned 65, she was eligible for Medicare in June and, when she decides which plan to use, being on the health care system will cut her costs considerably.
"I think it’s great that hospitals … have not only informative discussions, but for the doctors to take the time out of their busy schedule to come and talk to people," she said.
Linda Edwards has a disability and went on Medicare 12 years ago.
"You have to educate yourself Every year, we get big thick book about Medicare, and most people just throw it away. You should read that," she said.
Another session is planned at 11 a.m. Oct. 10 at Spring Valley Hospital Medical Center, 5400 S. Rainbow Blvd. For more information, call 853-3000.
Also, Centennial Hills Hospital Medical Center plans to have State Health Insurance Assistance Program (SHIP) counselors on site every second Wednesday. Register to meet with one by calling 388-4888.
The open enrollment period allows those already on Medicare to change plans, add or drop prescription coverage. During the Oct. 15-Dec. 7 period, one can also disenroll from Medicare Advantage plans and switch to Original Medicare. Any changes will go into effect the first day of January.
"Medicare open enrollment is coming early this year, and as people with Medicare make their health and prescription drug coverage choices, they will see that we’ve strengthened consumer protections and improved plan choices," said Centers for Medicare and Medicaid Services Administrator Donald Berwick, M.D. "Due to the Affordable Care Act, Medicare Advantage and prescription drug benefits are stronger than ever, and beneficiaries will continue to have access to a range of affordable products."
Visit medicare.gov, cms.gov/center/openenrollment.asp or call 800-633-4227 for more information.
Specifics were set to be unwrapped only two days ago, before this story went to press.
The past two years saw changes due the Afffordable Care Act such as requiring that wellness visits and preventative tests have no co-pay. Davis Sayen, Western regional administrator for Medicare, said 11,128 Nevadans took advantage of the new annual wellness visits last year.
The Department of Health and Human Services announced Sept. 21 that the Affordable Care Act means the average person with traditional Medicare will save $5,000 from 2010 to 2022. People with Medicare who have high prescription drug costs will save more than $18,000 over the same period.
Thanks to the health care law, the report said, seniors and people with disabilities in Nevada already have saved $26,312,523 on prescription drugs since the law was enacted. Seniors in Nevada in the Medicare prescription drug coverage gap known as the "donut hole" have saved an average of $576 in the first eight months of 2012. In addition, during the first eight months of 2012, 121,165 people with original Medicare received at least one preventive service at no cost to them.
The bill cut $716 billion from the Medicare budget through various means, prompting many seniors to fear reduction of their coverage. Sayen said the opposite is true.
"Since the Affordable Care Act, benefits have expanded, so we know, at least for next year, the benefits are better than what they were in the past," he said. "And there’s nothing in the law that curtails benefits any time in the future … What we are trying to do is buy those benefits more efficiently, so when you look at projections on spending for Medicare won’t grow as quickly under the Affordable Care Act, that’s because we’re choosing strategies to purchase the services more efficiently. We are not reducing the extent of the program by reducing the benefits or raising the co-payments or anything like that."
According to the Congressional Budget Office, roughly a third of the $716 billion was achieved by stopping the automatic annual increase in reimbursements to hospitals. Another cut involved reducing overpayments to insurance companies for Medicare Advantage plans (private competitors to standard Medicare). There also were cuts in reimbursements to various other health care providers.
About $145 billion will be saved by phasing out overpayments to private Medicare health plans over a period of 10 years.
The health care law also has saved consumers an estimated $2.1 billion on health insurance premiums, according to the Department of Health and Human Services. For the first time ever, it said, new rate reviews have been installed to prevent insurance companies from raising rates with no accountability.
"The health care law is holding insurance companies accountable and saving billions of dollars for families across the country," said HHS Secretary Kathleen Sebelius. "Thanks to the law, our health care system is more transparent and more competitive, and that’s saving Americans real money."
Lauren Koutsoumbas, insurance agent and owner of Cornerstone Benefits and Insurance, cornerstonevegas.com, said that during the enrollment period that begins this month, seniors on Medicare can make any change, as many times as they like.
"The last application they submit will be the one that sticks," she said.
Koutsoumbas added that, historically, from what she has seen in her 500-person client base, about 30 percent of seniors will change their plan during the enrollment period.
A second enrollment is slated from Jan. 1 to Feb. 14. During the second enrollment, those in Medicare Advantage can go back to original Medicare and get a different prescription drug plan.
Koutsoumbas said Las Vegas has a high HMO population as a whole on Medicare "because HMOs have lower costs, there is cost sharing, the co-payments are lower, most of the HMOs in Clark County have no monthly premiums, there is often a zero co-pay for your primary physician, so the cost for the HMOs are much lower than the other plans."
Sean Retke, insurance broker and also an owner of Cornerstone Benefits, said there are as many as 15 Medicare plans available in Las Vegas. If he were in charge, what would he do to change Medicare?
"I would say giving seniors more options, a larger networks of doctors … Medicare is great," Retke said. "If you had to go to private insurance, 80 or 90 percent of people could not afford it. It would be more than their Social Security retirement checks. So I would offer more plans, more types of plans and more doctors."
What’s the biggest misconception about Medicare?
"One of the big ones is when you get the Medicare Advantage plan, people are being told that they lose their Medicare and that is untrue," Koutsoumbas said. "That misconception causes so many problems with our seniors that can be financially devastating. That is a huge misconception. I wish somebody would put a big banner up in the sky to tell these guys that when you get an HMO, PPO or private fee for service, you do not lose your Medicare. You still have it."
Contact Summerlin/Summerlin South View reporter Jan Hogan at firstname.lastname@example.org or 387-2949.Find out which plan is best for you
Those on Medicare can use the Medicare Plan Finder, available at medicare.gov, to compare each plan’s quality summary rating from the previous year, identify which drugs may or may not be on a plan’s formulary or be restricted, and compare the cost ranges for plans available in their community. It includes a rating system to help make choices.
Medicare’s toll-free help line, 800-MEDICARE (800-633-4227), has representatives available 24 hours a day, every day of the year to answer questions on Medicare coverage.
Yet another way to get information is to make an appointment with your local State Health Insurance Assistance Program (SHIP). SHIP counselors can help you compare various plans until you find the right one. They can also help you enroll in that plan. SHIP isn’t affiliated with any insurance company and won’t try to sell you insurance.
All people with Medicare receive a copy of the "Medicare & You" handbook in the mail each fall. This booklet has a wide range of information about what Medicare covers and what it costs. It includes details about Original Medicare as well as privately run Medicare health and prescription drug plans that you can join.