Finding the Right Plan During Medicare Open Enrollment

open enrollment 2016It’s that time again for the nation’s more than 54 million people who get health coverage through Medicare to decide what they want in 2016.

Lynda Flathers just got a packet of information in the mail about changes to her Medicare Advantage plan for 2016. Although happy with her current coverage, Flathers wants to make sure that her plan is still her best option. So she’ll shop during Medicare’s open-enrollment period, which got underway Thursday and runs through Dec. 7. Still, she’s a bit reluctant.

“It can be kind of confusing, and you just never know if you’re making the right decision,” says Flathers, a 65-year-old from Chino who works in fund development.

Medicare beneficiaries can change their Medicare health plans and prescription drug coverage during Medicare’s annual open-enrollment period.

Like Flathers, many seniors find shopping for Medicare Advantage and Part D prescription drug plans overwhelming.

Experts suggest steps to finding the right plan.

Let George Help! “Most people, once they select a plan, they tend to stay with that plan,” says Ronald Bolding, president of Pomona-based Inter Valley Health Plan. And that may be fine. But the cost and benefit details of Medicare Advantage and stand-alone Part D drug plans change every year, so the plan that was the least expensive option in 2015 may not be for 2016.

“I do not remember a time when we did not make some kind of adjustment” to benefit designs, says Sherry Stanislaw, senior vice president with SCAN, a Medicare Advantage plan based in Long Beach.

Those changes can be costly. A recent survey of 49,000 people using to compare Medicare plans found that only 8% of those enrolled in Medicare Advantage and only 5% in a stand-alone Part D policy had the lowest-cost plan. Those who switched to a new Part D drug plan saved nearly $700 in 2015, and were 20% less likely to hit the prescription drug coverage gap.

Review all plan costs. Monthly premiums across all Medicare Advantage plans being sold in California for 2016 average $29.85. The highest premium is $221 per month, and the lowest is zero, according to an analysis by Health Pocket, a technology company that compares health plans. Nearly half of the Medicare Advantage plans available for purchase in California will have no monthly premium at all.  For prescription drugs, the average Part D premium in California is $61.78. But averages are just that.

Our big take-away is to look at not how has the market changed, but how has my plan changed with regard to the medications and services I use,” says Casey Schwarz, senior counsel for education and federal policy with the Medicare Rights Center. That means looking beyond the monthly cost of your plan to examine all possible expenses.

“A lot of people use their premium to evaluate their plans, but that’s just one cost,” says Elaine Wong Eakin, executive director of California Health Advocates, a Medicare advocacy organization.

Carefully review the deductibles, co-pays and coinsurance you’ll be required to pay when you go for care. A plan with a low monthly premium may be more expensive in the long run if doctor visits or prescriptions come with high costs throughout the year, Wong Eakin says.

Review drug lists. Drug benefits in 2016 may be less generous in many plans as insurers increase costs, including deductibles and other out-of-pocket expenses.

Confirm that the medications you need are covered by your plan, and take time to understand the various rules you’ll need to follow.

Confirm that your doctors participate in your plan. “That’s one of the things to evaluate when looking at a plan for the next year is whether your providers will be in network,” Schwarz says. Going outside your plan’s network can be costly.

Check star ratings. Medicare has a quality rating system in which plans are ranked from one to five stars, with five the highest. Experts suggest choosing a plan with at least four stars, if available. Of the 37 Medicare Advantage plans offered in Los Angeles County for 2016, 19 received a rating of four stars or higher. Just four of the 25 stand-alone Part D drug plans earned four stars; none earned the top rating of five stars.

 It’s my pleasure from year to year to help you choose and be in the right plan for you. – George

Top 5 things to know about the health care law if you have Medicare:

Medicare Your Medicare coverage is protected.

Medicare isn’t part of the Health Insurance Marketplace established by the health care law, so you don’t have to replace your Medicare coverage with Marketplace coverage.  No matter how you get Medicare, whether through Original Medicare or a Medicare Advantage Plan, you’ll still have the same benefits and security you have now.


You don’t need to do anything with the Marketplace during Open Enrollment.

You get more preventive services, for less. Medicare now covers certain preventive services, like mammograms or colonoscopies, without charging you for the Part B coinsurance or deductible. You also can get a free yearly “Wellness” visit.

 You can save money on brand-name drugs. If you’re in the donut hole, you’ll also get a 55% discount when buying Part D-covered brand-name prescription drugs. The discount is applied automatically at the counter of your pharmacy—you don’t have to do anything to get it. The donut hole will be closed completely by 2020.

 Your doctor gets more support. With new initiatives to support care coordination, your doctor may get additional resources to make sure that your treatments are consistent.

 The health care law ensures the protection of Medicare for years to come. The life of the Medicare Trust fund will be extended to at least 2029—a 12-year extension due to reductions in waste, fraud and abuse, and Medicare costs, which will provide you with future savings on your premiums and coinsurance.



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5 Medicare Mistakes That You Must Avoid

medicare open enrollment oct 15You may have a lot of choices when it comes to Medicare. And the biggest one might be choosing to take charge of your Medicare decisions in the first place.

Medicare Open Enrollment (Oct. 15 – Dec. 7) is your chance to take charge. Here are 5 common mistakes that you don’t want to make during this time—and why.

1. Allowing automatic plan renewal to make your choice for you

Your Medicare Part D or Medicare Advantage plan renews every year on January 1, unless you decide to change it.

Automatic renewal may make your life easy, but it may not be the best way to make your Medicare decisions. Plans may change what they cover from year to year. They may also change what you will pay in deductible, premium, copay or coinsurance amounts.

Insurance companies review their plans each year to make sure they’re still viable. Shouldn’t you do the same?

2. Ignoring your plan’s Annual Notice of Changes (ANOC)

You will receive an Annual Notice of Changes (ANOC) from your Medicare Part D or Medicare Advantage plan in the fall. This document explains any changes in your plan benefits or costs for the upcoming year. The changes may affect your health care and your budget. Learn about what to look for in your ANOC.

3. Basing your plan choice on the premium alone

It’s easy to focus only on premiums when looking at Medicare costs. But it’s a good idea to look at the big picture, too.

A plan with a low monthly premium may charge a large deductible or have high copayments. You might prefer this if you rarely go to the doctor and don’t take many medications. But a plan like this could be expensive if you use health care services often, even with the low premium.

It’s important to think about all the out-of-pocket costs as well as your health care needs when choosing a plan.

4. Picking a plan because your spouse or friend has it

You might count on a friend’s word when deciding what new restaurant to try, but a Medicare Part D or a Medicare Advantage plan is a personal choice. What works for one person may not fit with the needs of another.

You may have several Medicare Part D plans or Medicare Advantage plans to choose from. It’s a good idea to look at all your options, keeping your health care needs and budget in mind. Coverage and costs may vary quite a bit from plan to plan.

5. Assuming you don’t qualify for help with Medicare costs

Several programs offer financial assistance with Medicare premiums and other costs. You may want to look into them, even if you think you might not be eligible. Call your State Health Insurance Assistance Program (SHIP) office to discuss your situation.

For any questions regarding Medicare please feel free to call us at 909-792-3300 or visit

–This information was provided by Medicare Made Clear