Changes come for Medicare enrollees

Fall is decision time for millions of Medicare beneficiaries because Medicare’s open enrollment period continues through Dec. 7.

There are more than 1.2 million Medicare beneficiaries in Tennessee who may be impacted not only by the open enrollment period, but also in changes to their Medicare benefits.

Teresa Botts works at the Lebanon Senior Citizens Center to help center members make sense of the sometimes bewildering array of choices they face.

"It's easy for anyone to become confused about Medicare," she said.

To help people at the center navigate the ends and outs of rule changes, she invites experts to visit the center to answer questions.

"I can't tell them what to do," she said. "But I can explain to them what their options are."

People with Medicare will see some significant changes to the enrollment rules this fall. If they miss the opportunity to make adjustments to their plans during the open enrollment period, most people will have to wait to make changes until the next open enrollment period. Both Part D and Medicare Advantage plan members must make plan changes now and have until Dec. 7.  

Botts recommends choosing a Medicare Part D drug plan based on the drugs you are taking, unless someone is a member of a Medicare Advantage Plan that includes drug coverage.

Medicare’s Annual Disenrollment Period will take place from Jan. 1 through Feb. 14. People with Medicare Advantage plans will only be able to return to original Medicare and join a stand-alone prescription drug or Part D plan. In the past it was possible to switch Medicare Advantage plans from Jan. 1 through March 31.

Also, due to recent changes in Medicare requirements and payments, insurers may opt to change plan benefits, provider networks and cost.

Plans might respond to the upcoming shifts in Medicare by:
• raising beneficiaries’ premiums and/or cost-sharing.
• reducing their network of providers.
• reducing extra benefits.
• making quality improvements to get bonuses.
• withdrawing from the marketplace entirely.

Others may not make dramatic changes. Beneficiaries should always check their coverage carefully each year to ensure they are enrolled in a plan that will continue to meet their health needs and budget.

State Health Insurance and Assistance Program counselors will be available to assist people with assessing their Medicare coverage options during this enrollment season. Medicare beneficiaries are encouraged to contact the local TN SHIP office as soon as possible to set up a counseling appointment. The number for beneficiaries to call is 877-801-0044.

"TN SHIP is great," Botts said. "If someone isn't sure what they need to do, they should call TN SHIP and they will help."

There are also changes to the Low Income Subsidy program that helps individuals with their prescription drug costs. Under the new 2012 guidelines single people with a monthly income of $1,396.25 or less and resources, such as checking/savings accounts, stocks and bonds, of $13,070 or less, and married couples with a monthly income of $1,891.25 or less and resources of $26,120 or less qualify for help with drug costs.

The TN SHIP program receives grant funding from the Centers for Medicare and Medicaid Services to provide direct, local assistance to Medicare beneficiaries through one-on-one, counseling sessions both in-person and over the phone, presentations, and public education programs. The national SHIP network includes more than 1,300 local sponsoring organizations supporting more than 12,000 counselors and staff. Last year, SHIPs served more than 2.5 million Medicare beneficiaries nationwide.

TN SHIP counselors can help Medicare beneficiaries:
• review current coverage.
• check qualification for low-income programs.
• compare plans with all available options.
• search for specific plans online that meet specific prescription and medical needs.
• give easy-to-understand answers to questions about Medicare.
• help enroll in a plan online.

Botts said her best advice is for seniors not to take advice from any person or organization that stands to profit from a decision.

Mary Hinds can be reached at 615-444-3952, ext. 45 or mhinds@lebanondemocrat.com.