Mark Harvey — October is Medicare Part D time


NOT Obamacare!

I just wanted to see if you were paying attention … But if you need help navigating “Obamacare,” call any of the numbers at the end of this column. Now, it appears to me that we’ve stalled as long as we can, but the fact is, we’re into October.

Many of us would just as soon avoid October, because October means “open enrollment” for Medicare Part D and Medicare Advantage Plans, which means in all probability, a lot of work, hassle and migraines as we tiptoe through the minefields of health insurance. I’m sorry, and I can absolutely assure you that this was NOT my idea.

And I know well that this whole thing was made even more confusing with the advent of ObamaCare and the Health Benefits Exchange and tra la, but trust me: This is strictly about Medicare.

If you are not on Medicare, consider plowing through this with us so you could be of some service to people who are on Medicare and still think it’s September. If you are on Medicare, have your Part D or Medicare Advantage Plan in place, are just happy as can be with it and are absolutely convinced that nothing will change, then by all means, do nothing and, not surprisingly, nothing will change — the operative word there being “surprise.”

But maybe you like surprises — like changes in premiums or formularies or providers! OK, then, do nothing and continue enjoying the September calendar picture of the Petrified Forest, but the rest of us are moving on.

Ready? Take a breath? Holding hands? OK, here we go, because this year’s “open enrollment” happens from October 15th (ten days from today!) through December 7th so consider flipping that calendar.

Medicare Part D: “D,” as in “drug.” Drug coverage — insurance. It isn’t run by the Feds, like Parts A or B — these are plans, run by private companies, that are approved by the Feds. There are two ways to go:

What many of us do is have “traditional Medicare,” which means Part A (hospital, home health, hospice, etc), Part B (doctor, outpatient, durable medical equipment, tra la), a “MediGap” plan, to pick up the 20% that Medicare “approves” (but doesn’t pay for) AND a Part D plan – Yes, it is confusing;

What others do is have a Medicare “Advantage Plan,” which works (more or less) like a HMO (“health maintenance organization” or, what many call somewhat derisively, “managed care”), which provides all Part A and Part B coverage (usually, around here, through a “network” of providers) and (usually) Part D coverage — yes, it is confusing.

As of this writing, we don’t know which (if any) Advantage Plans will be available in our corner of the Universe, nor do we know which Part D plans will be available; remember, “surprise” was the operative term.

If you are “new to Medicare,” you get to sign up for these during the 7-month period that begins 3 months before the month you turn 65, the month you do turn 65 and ends 3 months after the month you turn 65. If you’ve been in the game for a while, you know that “open enrollment” means a specific period of time when you can change plans — “…and,” the newbie asks, “WHY would you do that?”

Well, because plans come and go, premiums change and formularies (the list of prescription drugs that a plan actually covers) change — oops! So, the plan that was your best-friend-forever this year, may not be so great next year, get it?

If you don’t sign up for a Part D plan when you’re first eligible, you will incur a “penalty,” which is 1% of the “national base beneficiary premium” times the number of months that you dithered about, and that amount will be added to your premium (if you ever decide to sign-up for a plan) AND it will never go away. IF you have prescription drug insurance from another source (e.g. retiree insurance) and IF it is deemed equivalent to Medicare Part D coverage, you then have “creditable coverage,” which exempts you from the dreaded penalty. If this is the case, your insurance will send you a letter telling you so — KEEP THE LETTER!

The “skeleton” of Part D, which we can imagine to be in four “sections,” looks like this, using my BFF (Mrs. Jones), as an example, using 2013 numbers, which are largely the same for 2014:

Mrs. Jones joins the “White Rabbit Part D Plan” on 1/1/13, and doesn’t get “extra help” (“Low Income Subsidy”), and pays the first $325 or so of her drug costs out-of-pocket, plus “White Rabbit’s” monthly premium — white Rabbit pays zero;

Mrs. Jones pays a copayment and White Rabbit pays a bunch, until their combined amount (plus the deductible from #1 above) equals $2,970;

Mrs. Jones now enters the legendary “donut hole” (aka, “coverage gap”) in which, basically, White Rabbit pays zero. The “good news” in 2013 is that Mrs. Jones will pay 47.5% of the cost of “covered” (meaning that they’re on the formulary) brand-name drugs and 79% of the cost of generics while she resides — uncomfortably! — in the donut hole;

If Mrs. Jones ends up spending $4,700 out-of-pocket, she emerges from the donut hole and enters the appropriately named, stage 4 “catastrophic coverage,” in which White Rabbit pays 95%.

Now remember, that was the “skeleton.” Different plans look different, e.g. some plans don’t have a “coverage gap” — will they be more expensive? Of course! And the premium has to be affordable and the formulary has to cover the drugs you take and what about this pharmacy vs. that pharmacy, and…

Right: Assuming that you don’t have the time, patience or endurance to carpet the backyard with the policies of umpteen Part D plans for in-depth review, the only practical way to do this is to utilize Medicare’s “Plan Finder.” You can do this by going to www.medicare.gov and clicking on “Find health & drug plans.” It will ask you to enter the drugs you take, dosages, how much you pay, where you want to get them, blah blah, then will spit out a few of what appear to be the best plans for you, beginning October 15th.

Local lore notwithstanding, the “Plan Finder” actually works pretty well for most people, most of the time, and you don’t have to be Bill Gates to navigate it, but if you’re not comfortable with computer stuff or don’t have one or your situation is “complicated” or or or, there is now (and will be) free help available. Just call any of the numbers at the end of the column and decent people will help you — for free — without trying to sell you anything, because they don’t have anything to sell. I promise.

Remember, this has NOTHING to do with “ObamaCare” or the “Health Benefits Exchange” or any of that, because if you’re on Medicare, you don’t care.

Look, this “Universe” is going to unfold, whether we like it or not, right? Sound a lot like “life?” Right, so we need to figure it out, deal with it and move on. Pretending it isn’t there only works with white rabbits, so go flip the calendar and continue holding hands.

Mark Harvey is the director of Information and Assistance for Olympic Area Agency on Aging. He can be reached at harvemb@dshs.wa.gov or 532-0520 in Aberdeen, (360) 942-2177 in Raymond or (360) 642-3634. FACEBOOK: Olympic Area Agency on Aging-Information & Assistance.