Making sense of Medicare, the government run health insurance plan for people with disabilities and those age 65 and older, isn’t easy. The options read like alphabet soup including Parts A and B (original Medicare), Part C (Medicare Advantage), and Part D (drug coverage).

Every year Medicare beneficiaries have a chance to change their coverage during the Medicare Open Enrollment Period, which begins on Oct., 15 and ends on Dec., 7. There are a number of things you need to know about Medicare and the open enrollment period.

You Can Switch Plans

Open enrollment is a time when people can change their Medicare Advantage and/or Part D prescription-drug plans. If you have Original Medicare with a Medigap supplemental plan and are happy with it, you need take no action. However, it might be a good idea to evaluate your Medicare Part D plan to ensure it’s still the best fit for you in 2016, as Part D plans can change in premium, formulary changes, and co-pay amounts.

During open enrollment, you can join a Medicare Advantage plan or a Part D prescription drug plan for the first time. If you are already in one of these plans, during open enrollment you can switch if you so choose. If you are happy with your current 2015 plan and satisfied with the changes to your plan for 2016, then you will need to do nothing and you will be automatically enrolled back into the same plan for 2016. Many carriers are considering value added benefits such as gym memberships, eye wear coverage, and dental.

Consider Columbia River Insurance Services your “go to” insurance agency in Vancouver. We have helped thousands of clients with their Medicare insurance needs – so we are experienced in what we do. We are an independent insurance agency and we represent many different carriers. We have vast experience with Medicare related insurance and always strive to obtain the best coverage for our clients, that will serve them most efficiently. Call us today and speak to any of our medicare agents in Vancouver, or if you prefer, you may speak to one of our medicare agents in Portland. You may reach us in Vancouver at 360-883-5776 and in Portland at 503-382-9091. Read on to learn more about what you need to know when Open enrollment rolls around this year.

Parts C and D Cover Additional Services

More than 14.5 million people—or about 28% of the Medicare population—are enrolled in Medicare Advantage plans. These plans allow seniors to receive both Medicare Parts A and B benefits through a private health insurer that contracts with Medicare. Plans cover hospitalization, outpatient care, and often prescription-drug coverage under one plan. Many plans also kick in extra services that original Medicare doesn’t cover, such as dental and vision care. Part D plans cover the cost of prescription drugs for which Original Medicare alone doesn’t pay.

You Have until Valentine’s Day to Drop a Plan

Between January 1, 2016, and February 14, 2016, you can drop your Medicare Advantage plan and return to Original Medicare. If you get out of a Medicare Advantage plan and return to Original Medicare during disenrollment, you’re also allowed to pick up a Part D plan, but you don’t necessarily have the right to pick up a Medigap plan.
Medigap is another type of private insurance that works with Original Medicare to help cover out-of-pocket costs and is used by about 20% of Medicare beneficiaries. With some exceptions, you’re only guaranteed a Medigap plan within the first six months of both being 65 or older and being enrolled in Medicare Part B. After that, unlike with Medicare Advantage plans, you can be denied coverage based on your health.

Quality is Rewarded!

Because of provisions in the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) began to financially reward Medicare Advantage plans that earn high ratings.
The CMS also allows for a special enrollment period only for those Medicare Advantage and Part D plans that have earned the top five-star rating. If you choose to sign up for one of these top-rated plans you get extra time to enroll. To encourage Medicare beneficiaries to choose top-rated insurers, anyone can move to a five-star Medicare Advantage or Part D drug plan (or a plan that covers both) at any time during this period—but this change can be made just once.

Look Past Premiums!

Steve Davis, President and CEO of Columbia River Insurance Services states, “The monthly cost, or premium, of a plan doesn’t tell the full story of how much you’ll pay for your health care. Most important for someone who thinks they’ll be a heavy user of health care services is the total out-of-pocket maximum. That means adding up all possible costs including monthly premiums, copays, coinsurance, and deductibles, so you’re clear about what your total spending could be for a given year.”

Check Your Medications

You should look carefully at which drugs are covered under the plans you are considering for 2016. Check the plan’s formulary and make sure the drugs you need are on the list. Also, know the plan restrictions. Sometimes a drug is covered but there may be a restriction like prior authorization or a quantity limit, so you should look into those things to see what you need to do to access your drugs.

A growing number of plans are adopting a network pharmacy benefit. That means some pharmacies will be in your plan’s network and others will be out-of-network. You’ll pay more out-of-network so be sure to check that the pharmacies near you participate with your plan.

To reiterate, consider Columbia River Insurance Services in Vancouver your “go to” insurance agency. Our experienced Medicare insurance agents in Vancouver and in Portland are available to answer all of your medicare related questions.

In Vancouver we’re located at 1503 NE 78 Street, Suite 1A, Vancouver, Wash., 98665. In Portland, we’re located at 12604 SE Stark St., Portland, Ore., 97233.