Medicare enrollment begins Oct. 15: What you need to know from (alphabet) soup to nuts [Asbury Park Press]

New Jersey seniors selecting their 2022 Medicare plans will see a nudge toward exercising and eating right in what insurance companies hope is a bid to keep them out of the hospital.

Toward that end, insurance agents said, plans are expanding their benefits beyond hospitals, doctors and prescription drugs to cover gym memberships, transportation, over-the-counter drugs and even healthy food.

"They are encouraging people to stay healthy, be healthy, get physicals, things like that," said Derick Buckley, owner of Buckley Insurance Group in Brick.

Medicare's open enrollment begins Oct. 15 and lasts until Dec. 7, giving some 1.6 million New Jerseyans a chance to review and make changes to their health insurance plans.

This year's signup comes as Congress debates adding dental and vision benefits and allowing the secretary of Health and Human Services to negotiate prices with prescription drug makers.

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For now, though, seniors have plenty of work to do to sift through their options and decipher an alphabet soup, trying to distinguish Medicare A, B, C and D.

Their choices:

Medicare consists of Part A, which covers hospital care and Part B, which covers services such as doctor visits and lab tests.

The primary benefit: Seniors can go to any doctor or hospital that takes Medicare nationwide, usually without needing a referral.

However, beneficiaries could face out-of-pocket costs through premiums, deductibles and co-pays. For 2021, seniors with Part B, for example, had a monthly premium of $148.50 or more, depending on their income; a deductible of $203; and co-pays of 20% after the deductible was met.

There also is no out-of-pocket limit.

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Seniors who opt for original Medicare can get Medigap that's provided by private insurers and pays for out-of-pocket costs not covered by Medicare.

Medigap policies don't cover services such as long-term care, vision, dental care and hearing aids.

Medicare Part D provides coverage for prescription drugs.

The plans are administered by private companies. Monthly Part D premiums for 2021 ranged from $0 to $77.10 depending on consumers' income.

New Jerseyans have about two dozen drug plans from which to chose, and they come with out-of-pocket costs. A "coverage gap," for example, requires consumers to pay for 25% of the drug costs after they reach $4,430 until catastrophic coverage begins — after $7,050 for 2022.

Experts said New Jerseyans could be in for changes. Wellcare is cutting the number of drug plans from six to three, experts said.

Their advice: Go to Medicare.gov to compare drug plans and find savings.

One option: Seniors with diabetes can search for a plan that participates in Medicare's Senior Savings Model, which caps some insulin products at $35 for a month's supply.

"They should definitely be shopping for their drug plan," said Toby Stark, owner of Stark Associates Insurance Agency in Tinton Falls.

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New Jerseyans can replace original Medicare with Medicare Advantage.

Known as Part C, Medicare Advantage plans are operated by private insurers and often include lower premiums; extra benefits such as prescription drugs, dental, vision and hearing; and yearly limits.

The drawback: Consumers in many cases need to see doctors in the plan's network, and might need referrals to see specialists.

In New Jersey, 32% of Medicare recipients have Advantage plans, lower than the national average, but growing fast. Five years ago, just 16% of New Jerseyans had Advantage plans, according to Kaiser Family Foundation, a health care research group.

Finding the right one requires research. Most counties offer more than 30 plans. And the market, which includes United HealthCare, Aetna, Cigna and Clover, has been joined by Braven, which was formed in 2020 through a partnership among Hackensack Meridian Health, RWJBarnabas Health and Horizon Blue Cross Blue Shield of New Jersey.

Braven, for example, is offering 24 hours a year of in-home support services — transportation for grocery shopping, medication pickup and doctor's appointments, as well as light house help, said Kerri Buckley of the Buckley Insurance Group.

"We've been fortunate to have very competitive Medicare Advantage plans every year with no monthly premium," Derick Buckley said. "They're actually getting better."

Michael L. Diamond is a business reporter who has been writing about the New Jersey eocnomy and health care industry for more than 20 years. He can be reached at [email protected].

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