Oct. 25--If Kim Ward has one piece of advice for every senior navigating the "Medicare Maze," it's this: Even if you're happy with the plan you've been enrolled in, even if you don't think you want to change, check to make sure your plan hasn't changed to exclude your prescription drugs and the doctors you see.
"This year is probably the biggest amount of changes" to Medicare Advantage plans in a while, said Ward, coordinator for the federally funded Tennessee State Health Insurance Assistance Program (SHIP), which provides free Medicare information and counseling to senior citizens. "Everything that was covered last year might not be covered this year."
About 80 people packed a room in the Blount County Public Library on Wednesday afternoon to quiz Ward about Medicare changes during a program co-sponsored by the library and the Blount County Office on Aging.
Much discussion revolved around whether to choose traditional Medicare with a supplemental plan or Medicare Advantage, in which the government contracts with private insurers such as Humana, United HealthCare or Windsor. About a quarter of Medicare beneficiaries use Advantage plans, which manages all the care.
"It's confusing because there are so many options," Ward said, and there are pros and cons to each.
Advantage plans require referrals to in-network providers, and the insurer can decide what qualifies as "emergency care" if out-of-network care is needed. Certain services -- mental health or physical therapy, for example -- may be limited. But they can be more affordable and can be tailored to cover certain chronic conditions, such as diabetes or osteoporosis, Ward said.
However, she advised seniors who choose Advantage plans not to have their premiums automatically deducted from their paychecks because of an ongoing glitch in the system. Get a coupon book and mail the payment in instead, she said.
Traditional Medicare plans can be more costly and require an additional plan to cover prescriptions, but those using them can go to any provider, anyone who accepts Medicare without a referral.
Seniors who travel frequently might find that a better option, she said.
Ward's office, at 1-877-801-0044, can help seniors compare plans. But computer-savvy seniors can do it themselves online, she said, inputting their ZIP codes at medicare.gov, printing out plans in their area and then calling the insurers for pricing.
They also can go online at www.ssa.gov or through SHIP to see if they qualify for government savings programs or subsidies to help pay their Medicare premiums, said Kristi Tucker, volunteer coordinator for East Tennessee Area Agency on Aging and Disability.
"A lot of people think because they have resources, they won't qualify," Tucker said. "That's not the case anymore."
Seniors raising grandchildren should see if they qualify for aid, because it's possible those could be counted as dependents.
Audience members had several questions about the Affordable Care Act, but Ward was limited in what she could answer.
The government did reduce some reimbursement to Advantage plans, saying they were being "overpaid" by coding patients as "sicker" than under traditional Medicare, and began to award "star" ratings to plans. Though there was concern that might increase Advantage premiums or limit plan options, Health and Human Services Secretary Kathleen Sebelius said earlier this year that premiums were down 7 percent and enrollment up 10 percent.
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