Letter to the Editor

Understanding Medicare

Friday, November 2, 2012

The majority of us over age 65 are signed up for Medicare Part A and B to cover a large portion of our hospital and doctor bills. In addition, the majority of us probably purchase a Medicare supplement policy from an insurance company which pays the majority of the deductible and co-pays that Medicare A and B do not cover. Medicare supplement policies are standardized, offering up to 11 different choices of coverage. One of the 11 choices for example, is plan F, but no matter which insurance company you purchase the plan F from, you can be certain the same basic benefits will be included. This is true of each of the 11 choices of Medicare supplement policies; they must be standardized. Due to the standardization of coverage, it may not be necessary for us to review these policies each year to see if there is something better. Generally, if you are satisfied with the coverage and cost, you will retain the same policy from year to year.

Prescription drug coverage under Medicare Part D insurance plans, however, is not standardized. Each insurance company establishes their own drug formulary each year, and chooses which drugs to cover and how to price them on a calendar year basis. For this reason, it is very important for "everyone" to review his or her coverage annually. The insurance companies provide a drug formulary and pricing to Medicare annually, and are required to have an open enrollment period from October 15th to December 7th each year, during which time everyone having a Part D plan is allowed to enroll in a different Part D plan for coverage starting the following January 1st, if it is beneficial to make the change.

The best place to compare plans and choices is at "medicare.gov". At that site you can enter your personal information including the medications you are using, and the program will list for you all of the plans available in Iowa and will show you the premium and cost of the prescriptions so you can compare which plan will be the most cost efficient for you. You can, from October 15th until December 7th, use medicare.gov to enroll in a new plan for 2013, and the enrollment will automatically cancel your current plan effective January 1, 2013. This option to change plans is available each year during this period of time and everyone should make use of the opportunity to change plans if it will be beneficial.

The Insurance Division of the State of Iowa also offers a service called "Senior Health Insurance Information Program" or SHIIP. SHIIP is managed by 8 employees of the Insurance Division of the State oflowa, who train and supervise approximately 370 volunteers in communities over the entire state. SHIIP volunteers are able to meet with you, and utilizing the medicare.gov site, can provide you with information that will enable you to determine which prescription drug plan or policy may be best for you for the coming year, and can enroll you in the new plan if you choose to do so. The service is free and SHIIP volunteers are impartial and are not allowed to promote one plan over another or one pharmacy over another, so you can rest assured the information you receive is unbiased and provided for your information.

The potential savings for you each year is significant. For those receiving assistance from SHIIP volunteers this past week in Buena Vista County, the annual savings from changing plans or policies ranged from a minimum of $250 up to several thousand dollars. There were several changes made to the formulary by insurance companies for the 2013 year compared to 2012, so just because your plan worked for you in 2012, it may not be the best for you in 2013. It is in your best interest to either use medicare.gov yourself to compare plans, or make an appointment with a SHIIP volunteer to do so. Most counties have a SHIIP volunteer, and in Buena Vista County you can make an appointment to meet at the sponsor/coordinator site which is Buena Vista Regional Medical Center by calling Danielle at 712-213-8683