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Tuesday | 1.16.2018
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Many Reasons to Switch Medicare Coverage for 2014, But Too Few Do

During Medicare annual open enrollment—Oct. 15 to Dec. 7—nearly 50 million people have the opportunity to potentially improve their healthcare coverage and lower their costs. However, many people don’t take advantage of this 54-day window to make changes, according to Allsup.com.

“Comparing plans and choosing coverage can be complex. As a result many people stay where they are, missing out on important benefits and cost savings, rather than deal with the complexity,” said Paula Muschler, operations manager of the Allsup Medicare Advisor®.

Only 15 percent of seniors report changing their Medicare plans in the past year or plan to change their Medicare plans in the next year, according to the Allsup Medicare Advisor Seniors Survey, using data collected in 2012.

“Medicare plans can change what they cover, or your own needs may have changed, or both,” Muschler said. “If you continue with the same plan next year, you could find your plan doesn’t cover things you thought it did or that you need, leaving you holding the bill.”

In fact, 43 percent of seniors said they have experienced unexpected costs for medications, treatments and doctor visits that Medicare did not pick up, according to the Allsup survey.

Reasons to Switch Medicare Coverage

Muschler outlined the following reasons why beneficiaries should review their Medicare plans during the annual open enrollment season and consider switching plans.

Change in health. Individuals who have developed a health condition in the previous 12 months that requires a new prescription drug or ongoing visits to a specialist should determine if another plan would better cover these new health needs.

A move or planned move. With the exception of Original Medicare, most Medicare plans have geographic restrictions. People who are moving need to check to see if they are leaving their plan’s service area. Their new location may offer additional plans that better suit their needs.

Change in healthcare providers. A number of developments could lead someone’s plan to no longer include their doctors or medical facilities. For example, physicians may retire or relocate, and medical facilities may change their terms. “If your doctor choice is important to you, this is a good reason to study your options and possibly switch Medicare plans,” Muschler said.

Change in plan coverage. Plans can alter the drugs, procedures and conditions they cover. For example, a prescription drug Part D plan may no longer cover the prescription drugs a policyholder needs to purchase in the coming year, or may put restrictions on how and where they purchase them. “Questions about prescription drug costs are one of the top concerns our Allsup Medicare specialists encounter,” Muschler said. “This is especially critical for those who fall into the prescription drug donut hole.” The donut hole is the gap of coverage in which the individual pays a greater percentage of the drug cost.

Change in plan costs. Premiums, co-pays or deductibles are increasing for many plans. Price changes occur year to year, so people need to examine what they have been paying and what they can expect to pay in the coming year. There may be alternative plans with lower costs available in their area.

The current plan is no longer available. In these instances, beneficiaries must select a new plan, or they may default to another plan chosen by the Centers for Medicare & Medicaid Services. “Sometimes plans are eliminated because the provider offers a similar plan, but it’s still important to compare that coverage to what you actually need in the coming year,” Muschler said.

With only about seven weeks during Medicare open enrollment, it’s important that people start their evaluation as soon as possible. “Reviewing your Medicare plan options earlier rather than later will put you in a better position to research your options and get the help you may need during the annual enrollment window,” Muschler said.


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