As individuals retire or age into Medicare, their insurance situation can change dramatically. There are a multitude of options open to those with Medicare. The terms are different, the prices are different, the products offered are dramatically different each year.
The purpose of this column is to give those who are eligible for Medicare, or soon to be eligible for Medicare, some understanding of their insurance options and how it could impact their health and finances.
These questions and answers are meant as a guide to help you understand the complex questions you are now thinking about. Each individual's specific situation may create a different solution. You shouldn't necessarily do what your friends, family and neighbors do.
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Janell Sluga
Q: Medicare is now showing a rating for the Medicare Advantage Plan and the prescription drug plans. What does this rating mean, and how do we find out more about it?
A: One of the newest changes to Medicare is the Medicare ratings system for prescription drug plans. Each plan that is available to Americans on Medicare has been given a rating. These ratings are from zero to five stars. These ratings are based on a number of quality markers. These markers include, but are not limited to: time on hold for pharmacists, ease of getting prescriptions, time decision about appeals, availability of foreign language interpretation or TTY/TDD services, accurate drug pricing information given to Medicare, timeliness of new enrollment requests, complaints to Medicare about the drug plan and many others.
The number of stars reflects the overall Medicare rating. One star is a poor rating, two stars is below average, three stars is average, four stars is above average and five stars is excellent. Any plan that has a below average or poor rating for three years in a row will have restricted enrollment until it improves its plan ratings. Those that have a five star rating are given the right to enroll members into their plan anytime during the year.
Those plans that are brand new in 2013 do not have a rating yet, as they are too new to be measured. This doesn't mean they are good or bad - just that they haven't been around long enough for Medicare to rate their performance.
If you have not made a change to your prescription drug coverage, or later on during 2013 you have problems or issues with your prescription drug plan, you can use this five star plan rating to your advantage. This rating system would allow you to join a five star plan available to us anytime during the year. This means that almost everyone will have a Special Enrollment Period open to them all the time.
In our region of Western New York, we have only one five star plan, and that is a stand-alone Part D plan. The name of the plan is BlueCross BlueShield Rx PDP, and the company is Excellus Health Plan, Inc. The cost of this plan is $47.60, and that is slightly higher than the average premium this year. It has a $325 deductible and no gap coverage. No gap coverage means that brand-name medications will cost 50 percent during the coverage gap, and generic medications will cost 79 percent during the coverage gap phase. This coverage gap becomes an issue if your medications cost more than $2,970 during the year.
Not all areas of the country have a five star plan, so we are lucky in that respect. This plan is a stand-alone drug plan, so it would be paired with original Medicare coverage for most individuals. Switching to this five star plan could be a way to get your medications covered if your current plan does not cover them and this plan does. This five star plan could also be used to get you out of the Medicare Advantage Plan you have and allow you to go back to original Medicare.
This is a Special Enrollment Period that applies to everyone and could be used to get you out of a plan that isn't working for you. You can switch to a Medicare prescription drug plan that has five stars for its overall plan rating through Nov. 30, 2013. The overall plan ratings are available at www.medicare.gov. You can also call 1-800-medicare for this information. Both the website and the phone number are available 24 hours a day, seven days a week. The 2013 "Medicare and You Handbook" also has some written information about the five star plan rules, but it may not have the ratings printed in your book. The ratings were not available at the time of printing for the mailing to most Medicare recipients.
You can only use this five star plan Special Enrollment Period once from Dec. 8, 2012, to Nov. 30, 2013. This option could be used to benefit you and your health care costs in many ways.
Janell Sluga is a geriatric care manager certified and works for Senior Life Matters, a program of Lutheran Senior Housing, and has worked in Chautauqua County with seniors for more than 18 years. She is HIICAP (Health Insurance Information, Counseling & Assistance Program) counselor-trained by Office for the Aging. She does not sell insurance or represent any insurance company. She is an unbiased source of insurance and education to help seniors choose the best option for them.
You may submit questions to be answered in later columns to Janell Sluga at Senior Life Matters, 737 Falconer St., Jamestown, NY 14701, or call 716-720-9797, or by email at janells@lutheran-jamestown.org.
Please remember that not all questions can be answered in this format, but as many as can be, will be.