Medicare open enrollment on tap

BULLHEAD CITY - Medicare's open enrollment period runs Oct. 15 through Dec. 7 and is the time of year when certain changes can be made to coverage.

According to the Western Arizona Council of Governments, those changes can include:

• Joining a new Medicare Advantage Plan or Part D prescription drug plan.

• Switching from Original Medicare to a Medicare Advantage Plan.

• Switching from a Medicare Advantage Plan to Original Medicare (with or without a Part D plan).

"The most important thing is access to care, that the doctor they want to see is available," said Noel Petrohilos, a licensed sales agent and owner of Pennwest Insurance Solutions in Laughlin. "Most plans are network based, but their preferred provider may not be on it."

Petrohilos said prescription medication coverage, followed by co-pay and coinsurance rates are the second and third most important aspects to choosing a Medicare health plan.

Folks who want to keep their current plan don't need to take any action during open enrollment. However, there are many things to consider if you are choosing a new plan.

The WACOG says you should ask yourself the following questions before choosing a Medicare Advantage Plan:

• How much are the monthly premiums, if any?

• How much are deductible and coinsurance/copay amounts for the services I need?

• What is the annual maximum out-of-pocket cost for the plan?

• What service area does the plan cover?

• Are my doctors and hospitals in the plan's network?

• What are the rules I must follow to access health care services and my drugs?

• Does the plan cover additional health care benefits that are not covered by Original Medicare?

• What is the plan's star rating?

• Will this plan affect any additional coverage I may have?

• If leaving Original Medicare and a Medigap for a Medicare Advantage Plan: Will I have the right to purchase a Medigap again later if I switch back to Original Medicare?

Before choosing a Part D drug plan, WACOG recommends that you ask yourself the following questions:

• Does the plan cover all the medications I take?

• Does the plan have restrictions on my drugs?

- Prior authorization means that you must get approval from your Part D plan before the plan will pay for the drug.

- Step therapy means that your plan requires you to try a cheaper version of your drug before it will cover the more expensive one.

- Quantity limits restrict how much of a drug you can get per prescription fill.

• How much will I pay for monthly premiums and the annual deductible?

• How much will I pay at the pharmacy (copay/coinsurance) for each drug I take?

• Is my pharmacy in the plans' preferred network?

• Can I fill my prescriptions by mail order?

• What is the plan's star rating?

• If I have retiree coverage, will the Medicare drug plan work with this coverage?

Several organizations are hosting seminars, workshops and sales events in the Bullhead City and Laughlin areas to help seniors choose the best Medicare health plan for them.

• Pennwest will be hosting six meetings at the Laughlin Public Library to answer Medicare enrollment questions. The dates are: Oct. 22 and 28, Nov. 5, 12 and 19, and Dec. 3. All meetings begin at 11 a.m.

• Medicare Insurance Compare will host two seminars at the Bullhead City Public Library on Oct. 18, from 10 a.m. to noon and from 3-5 p.m.

• CSG Medicare Pros has two events scheduled at the Bullhead City Public Library on Oct. 19, from 9:30 a.m. to noon and and from 1-4 p.m.

• Physicians Mutual will host an event at the Bullhead City Public Library from 1:30-3:30 p.m. Nov. 4.

It's also important to keep an eye out for frauds and scams during the open enrollment period.

Medicare health plan representatives are allowed to send mail and emails but are not allowed to call or visit someone without the person's permission.

Prospective enrollees also should try to avoid:

* Anyone who tries to pressure them to join a plan.

* Anyone who claims they represent Medicare and wants to offer free services.

* Anyone threatening that someone will lose their Medicare benefits unless they sign up for a certain plan.

Medicare recipients can compare plans on the official Medicare website at medicare.gov.

And if you do decide to change your Medicare coverage, you can do so by:

• Calling 800-MEDICARE to make changes over the phone.

• Going to www.medicare.gov to make changes online.

• Calling a plan directly to enroll (after getting all information in writing).

For more help with Medicare issues and to talk to a WACOG State Health Insurance Assistance Program Medicare Counselor call 800-782-1886.