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The Ohio Department of Aging

Ohio Department of Aging Boomerang: It all comes back to you!

Boomerang: It all comes back to you!

My Future - November 2010

They say I should review my Medicare plan, but what am I looking for?
Ask questions and don't just rely on provided information for the whole story

Each year Medicare provides beneficiaries with the opportunity to evaluate their coverage options for the upcoming year. The open enrollment period for this year is Nov. 15 through Dec. 31, 2010. Evaluating plans can be daunting, so many of us stay with what we've got as long as it seems to be working. But plan offerings and your situation may change, and while your current plan may be okay, there might be something better out there.

During open enrollment, people with Medicare can stick with the coverage they currently have or select one of several coverage options.During open enrollment, people with Medicare can stick with the coverage they currently have or select one of several coverage options, including original Medicare, original Medicare with a supplement or stand-alone prescription drug plan or a Medicare Advantage plan that offers comprehensive health benefits that may include prescription drugs.

By now, you should have received a notice from your current plan about coverage and cost changes for next year. If you haven't, call them and ask for it. When considering all your options for next year, the Ohio Senior Health Insurance Information Program (OSHIIP) recommends you look first for the "three Cs":

  • Convenience - Is the plan accepted by the pharmacies you prefer to use? Is there a mail-order program that will allow you to have your medicines sent directly to your home?
  • Cost - What are your total out-of-pocket expenses? Specifically, you'll want to know about the premium, deductible and copayment or coinsurance amounts.
  • Coverage - Does the plan cover the drugs you take or are likely to need? Do any of your drugs require prior authorization? Is there a coverage gap in the plan?

The materials your plan sends tend to be generic and provide you only part of story. The Medicare Rights Center says you need to contact your plan to get specific information about your coverage:

  • Plans are only required to send you a shortened list of covered drugs (called a formulary), not the full list. Representatives on the phone should be able to check for your specific medicines.
  • If, in the current benefit year, your doctor had to make a special request for your plan to cover a drug for you, and you are still taking the medicine, ask the company what you must do to make sure the plan keeps covering it.

Once you have a good idea of what your current plan offers and what it will cost, you can compare it to other plans. You can find the available plans in your area by calling 1-800-633-4227 or visiting www.medicare.gov. But, don't just rely on the information these resources provide. Contact other plans and ask them the same questions you asked your current plan.

If you have questions about your coverage options or need help enrolling, OSHIIP, a service of the Ohio Department of Insurance, can help. Call them at 1-800-686-1578.