2012-10-04 / General Stories

Time to Shop for Best Medicare Deal

by Bob Moos

Now’s the time for Texans with Medicare to check their health and drug coverage for 2013. Medicare’s open enrollment period runs from Oct. 15 until Dec. 7. Open enrollment is the best time to make sure your health and drug plans still meet your individual needs, especially if you’ve had any changes in your health.

By now insurers should have notified you of any adjustments in your health or drug coverage or any changes in your out-ofpocket costs for next year.

The average monthly premiums for Medicare Advantage plans will inch up $1.47 to $32.59, while the average monthly premiums for basic drug plans will hold steady at about $30.

Medicare Advantage remains a strong alternative for people who prefer to receive care through a private insurer rather than through Medicare’s original fee-for-service program.

Enrollment in the private Medicare Advantage plans is expected to grow by 1.5 million to 14.5 million people in 2013 – almost 30 percent of Medicare beneficiaries.

Even if you’ve been satisfied with your health and drug coverage, you may benefit from reviewing all your options. Shopping around may save you money or improve your coverage.

Texans in Medicare’s original fee-for-service program can choose from 32 drug plans with monthly premiums ranging from $15 to $108 – about the same number of plans and premium range as last year.

Look beyond premiums, though. The only way to determine the true cost of your drug coverage is to consider other factors like deductibles, copayments and coinsurance.

Medicare’s website – www.medicare.gov – has the best tool for helping you narrow your search for a new health or drug plan. Just click on “Find Health and Drug Plans.”

After entering your ZIP code and the list of your prescriptions, you can use the “Medicare Plan Finder” tool to compare your coverage and out-of-pocket costs under different plans.

The quality of a health or drug plan’s customer service should be considered, too. To help you identify the best and worst, the Plan Finder provides star ratings for each plan.

A gold star will show plans with the highest, five-star rating, while a warning icon will alert you to plans that have performed poorly for at least the past three years.

One-on-one benefits counseling is also available through your State Health Insurance Assistance Program. In Texas, you should call 1-800-252-9240.

Thanks to the health care law, you’ll enjoy more savings on your prescriptions in 2013 once you land in the coverage gap, known as the “doughnut hole.” You’ll receive a 53 percent discount on your brand-name drugs and a 21 percent discount on your generic drugs while in the gap.

The doughnut hole begins once you and your drug plan have spent $2,970 for your drugs.

More than 109,000 Texans have saved more than $67.2 million on their prescriptions so far this year.

If you’re having difficulty affording your medications, you may qualify for extra help with your drug coverage premiums, deductibles and co-payments.

The amount of help depends on your income and resources. But, generally, you’ll pay no more than $2.60 for generic drugs and $6.50 for brand-name drugs.

Thirty percent of Texans with Medicare’s drug coverage now get such a break.

To learn more about whether you qualify for extra help, visit www.socialsecurity.gov/ prescriptionhelp or call Social Security at 1-800-772-1213.

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