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Why You Still Need to Reassess Your Medicare Coverage

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Making the right choices for your healthcare starts with the right coverage.

If you are a senior living on Medicare, your yearly open enrollment period is now open. It lasts through December 7. Any changes made now to your healthcare coverage will take effect on January 1.

Here’s what you need to know for 2014.


If you have a traditional Medicare plan, you need to make sure you sign up for prescription coverage.

Traditional Medicare (Parts A and B) covers only hospitalizations and outpatient visits and is subject to a $1,184 deductible per hospitalization benefit period.

Medicare A and B cover all surgeries, tests, labs and supplies that are “medically necessary.”

If you already are on traditional Medicare and are satisfied with your current coverage, you may not need to do anything during this open enrollment period. However, traditional Medicare does not cover prescriptions— for this you will need to purchase Medicare Part D.

Medicare Part D premiums vary by provider and state.

According to the New York Times, it is expected that you’ll have more choices for how you receive prescription coverage in your senior healthcare this year, but most Part D plans are now instituting preferred pharmacy networks, which may place limitations on where prescriptions may be filled with insurance coverage.

The government has estimated that the average cost of Medicare D plans will be around $31 per month for 2014. If you are purchasing a prescription coverage plan this year, make sure you carefully check the terms and costs (including premiums, deductibles and co-insurance amounts) before you commit to a provider.

Understand what you’re getting if you opt for a Medicare Advantage Plan.

If you are opting to purchase, or renew coverage with, a privatized Medicare Advantage (MA) plan, make sure you shop carefully.

Although MA plans usually provide all-in-one coverage for doctor visits, hospitalizations and prescriptions, their coverage amounts and costs vary by provider, state or even by different regions within a given state. So, what a friend in Arizona is getting may not be something available here in Cincinnati.

The US Department of Health and Human Services estimated that the average monthly Medicare Advantage premium in 2014 is expected to be just over $32, but some plans may be higher or lower than this amount. Some MA plans feature low premiums, but can have higher out-of-pocket costs (deductibles, co-pays and co-insurance), than others. For a senior living on a fixed income, every penny counts.

If you are considering an Advantage plan for 2014, research the plans available in Cincinnati. Compare and contrast their costs and provider networks, as they pertain to your financial and coverage needs. A little time spent shopping now could save you big dollars in the long run.

Is open enrollment the same as “Obamacare” enrollment?

No.  The Affordable Care Act (colloquially known as Obamacare) pertains to commercial insurance plans, not to Medicare plans. Though Obamacare will not affect coverage in any way for traditional Medicare recipients, those people currently on Medicare Advantage plans should check with their providers to see if any of their costs will change.

The Affordable Care Act does have expenditure-controlling provisions which require payments made by the government to privatized

Medicare plans to be more in line with traditional Medicare payments made to providers. As a result, some Medicare Advantage providers may attempt to raise patients’ premiums or out-of-pocket costs— a phenomenon known as “cost-shifting.”

If your current MA plan’s costs increase, shop around other plans available in Cincinnati to ensure you will not pay more than you need to for the same amount of coverage.

Where do I go for enrollment?

Open enrollment is available online on the federal government’s official Medicare website.

Once there, you can check your existing healthcare coverage, research the providers and plans available in Cincinnati and make your selections. If you are a traditional Medicare recipient, you need only shop Medicare D (prescription) plans and make your choice for 2014.

If you want to purchase a Medicare Advantage policy to replace your Medicare A/B/D plans or want to compare your current MA plan to other available policies, you can do so here.

Once again, do not confuse Medicare open enrollment for “Obamacare” enrollment (which is accomplished via the website). If you have questions about open enrollment, talk to a geriatric care manager or speak to a Medicare representative at 1-800-633-4227.

Bryan Reynolds
November 27, 2013
Bryan Reynolds is the Vice President of Marketing and Public Relations for Episcopal Retirement Services (ERS). Bryan is responsible for developing and implementing ERS' digital marketing strategy, and overseeing the website, social media outlets, audio and video content and online advertising. After originally attending The Ohio State University, he graduated from the College-Conservatory of Music at the University of Cincinnati, where he earned a Bachelor of fine arts focused on electronic media. Bryan loves to share his passion for technology by assisting older adults with their computer and mobile devices. He has taught several classes within ERS communities as well as at the Osher Lifelong Learning Institute run by the University of Cincinnati. He also participates on the Technology Team at ERS to help provide direction. Bryan and his wife Krista currently reside in Lebanon, Ohio with their 5 children.

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