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October 29, 2010 > HealthCare...Who Cares?

HealthCare...Who Cares?

By J. Dennis Wolfe

To all who read my inaugural column thank you for such great feedback.

Dramatic changes for senior citizens are here. So let's address the Open Enrollment Period that starts November 15, 2010 and ends December 31, 2010. In early 2010 and previous years there was another enrollment period January 1st through March 31st. It allowed changes to another Medicare Advantage (MA) Plan, including your original plan. There was flexibility, but neither the government (CMS) nor insurers could process paperwork fast enough for all the changes made during this three month window.

Action Item! That second enrollment period is gone for 2011. Whatever plan you select in this Fall's Election Period November 15, 2010 through December 31, 2010. is what you will have for all of 2011.

If you wish to disenroll from the plan you selected during this Fall Annual Election Period, you can still do so starting January 1st and ending February 15th. But, if you do so, the only option available is to go back to original Medicare, and if you wish, pick up a stand-alone prescription drug plan.

However, if you disenroll during this 45-day window from a Medicare Advantage plan and still would like to go back to a MediGap policy, evidence of insurability will likely be required by the insurers; there is no guaranteed issue. Be exceptionally alert this Fall and choose wisely.

If you have credible coverage now, be it a MediGap or a Medicare Advantage plan, I would urge caution and a thorough review all documents presented at any broker-organized sales meetings. Do not be intimidated. Ask questions. Bring family members.

I have been asked many times about Medicare Advantage (MA) and how is it different from original Medicare. MA products offer an alternative to provide cost-protection. I solidly believe in the MA program.

CMS, the federal agency that oversees Medicare, contracts with eligible insurance companies (Anthem, Blue Shield, Health Net to name three in California) who market MA products. These products typically have additional benefits such as limited vision and dental coverage, along with access to exercise facilities, etc. Premiums can be lower, in some cases significantly lower, than traditional MediGap policies.

Most MA products also make prescription drug coverage available and are known as Medicare Advantage Prescription Drug (Part D) products or MAPD. When you couple an MA product with a prescription drug program the result is a plan that looks markedly similar to traditional employer-sponsored group plans.

Like the common group plans MA's typically have an annual deductible and co-pays for doctor visits (slightly higher for specialists). Along with cost-sharing percentages, there is a maximum out of pocket limit of around $3,500. Worldwide emergency coverage is also provided.

In my next column I will discuss Prescription Drug coverage for Medicare also known as Part D.

Stay healthy. Stay tuned. Get involved. Learn what is being done. Your life now does indeed depend upon it.

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