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Navigating Health and Aging: It's not too late to change your Medicare plan

It's Nov. 30, and it's not too late to take advantage of the Medicare open enrollment period. Open enrollment started on Oct. 15 and will wrap up on Dec. 7.

During this time, you can change from your Original Medicare Plan to a Part C Plan — otherwise known as a Medicare Advantage Plan — or from a Part C Plan back to Original Medicare. It is also the opportunity to sign up for a Part D Plan (if you are not already enrolled in one) or explore changing your plan to get a better rate on your current pharmacy charges.

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The Original Medicare Plan includes Part A and Part B. Part A is considered to be hospital insurance and Part B covers outpatient costs. Part D, or prescription coverage, is not included. Part C, or an Advantage Plan, is essentially a health maintenance organization plan, or HMO plan. It usually includes medication or pharmacy coverage to some degree. Part C Advantage plans are accompanied by the same restrictions as HMOs. You must, in most cases, stay within their network of providers, hospitals and rehabilitation facilities. It can be extremely limiting and frankly (in my opinion as a nurse) extremely frustrating to navigate.

Original Medicare Part A and B allows freedom to choose one's own providers and pays without the co-pays often required by the HMO plans. It is wise to supplement the Original Medicare Plan with a "Medigap" or supplemental insurance plan. These plans are government regulated and must provide the same coverage for the designated plan, yet the cost is dependent on the underwriting company. For the same coverage, premiums can vary greatly. The Part A and B coverage combined with supplemental insurance will pay for 100 percent of hospital admissions (note: admission, not "observation").

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If you are currently in a Part C Advantage Plan and wish to move back to a Medicare A and B plan, it is now the opportunity to do so. The only catch is that if you have pre-existing medical conditions, you may be limited when choosing a supplemental plan. It is important to explore the options before making a change one way or another. There are constant infomercials currently trying to catch our attention for Advantage Plans, which sound very enticing. As always, I suggest when making such a big decision, keep in mind "buyer beware" and get all the information before acting upon a change.

Some of you may have received a notice from your current Advantage Plan HMO, such as Aetna, that they are no longer offering the plan and you must switch now. This is great news for those dissatisfied with current coverage. You have the opportunity to go back to Original Medicare and pick up a supplemental insurance coverage plan without the pre-existing condition limitations. This is all because the company is disenrolling you.

Many will not have the need or desire to change Medicare plans during this time. However, all should be reviewing their Part D plans. People are often under the assumption that once you sign up with a Part D prescription plan, you are obligated to stay with that plan or have no need to change. This is a huge mistake! Plans change all the time in regard to which medications they will cover (what they call their formulary list). They change the amount of money they will pay on certain drugs and change restrictions. I have clients who I have entered into the system and will save hundreds to thousands of dollars in 2015 by making a change to another Part D plan. It is a fairly easy process to complete online.

If you or a loved one wishes to investigate a potential plan change and potential savings, I will navigate you through the process. You will need someone to go online to http://www.medicare.gov. Next, go to the green box which says "find health and drug plans," and this will ask for "general info" or personalized search. (You will need your ZIP code that Social Security has listed, your Medicare number, effective date of Part A and date of birth).

•Step 1: Enter in the information.

•Step 2: Enter your current medications. Note: You must have the dosage and you must enter in how many pills you will need for one month. So if you take metoprolol 50 mg twice a day, then you type "metoprolol" in the search; select the dosage when it comes up; and select 60 pills for 30 days. Continue adding medications one by one until your list is created. You will get a drug list ID and password (the date) for future use if you wish to consider options and return to the site later.

•Step 3: Enter the name of the pharmacy you wish to use. Note: If your loved one resides in a facility, you must know the name of the pharmacy that provides their medications and that pharmacy's ZIP code. This can get tricky if you are trying to put in a local ZIP code but the pharmacy has a ZIP code in another state, such as Millennium (16066), for example.

•Step 4: Refine results. Unless you currently have a Part C Advantage Plan, you will check "Original Medicare." Continue to the "Plan Comparison Chart." You will see your current plan to the right in a small box where your drug ID is located. Below "Original Medicare," you will see the options for different plans. Compare the total you will pay for 2015 from your current plan with the top plans. Be sure to note the premium cost, deductibles across the top line of each plan. If you check the top two plans and your current plan, you will get a side-by-side comparison. At this time, you can enroll or you can come back to the site and everything is saved. You are under no obligation to switch if you enter in information. If your current plan is still the most comprehensive — great, keep it and you're done! If not, you have the opportunity to save a considerable amount of money.

For those who never signed up for a Part D Plan, you may sign up now, although you will incur penalty charges of 33 cents per month from the time you were eligible to sign up. If you were eligible two years ago, then 33 cents per month for 2 years ($7.92) will be added to your premium each month. This does add up if you were eligible from the time of inception of Part D in 2006, but you still can save a lot of money if you are taking multiple or expensive drugs. This is worth the time and effort. You can also call Medicare at 1-800-MEDICARE or 800-486-2048. Good luck!

Jill Rosner is a registered nurse, certified geriatric care manager and owner of Rosner Healthcare Navigation. She provides patient advocacy and care management services to clients with health and aging issues. Contact her at JillRosnerRN@aol.com.

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