Open enrollment offers those on Medicare a chance to change plans

QUINCY – I received a large, official-looking envelope in the mail recently with bold black letters: "Massachusetts Medicare Beneficiary Update."

"The Medicare Annual Enrollment Period has already started," it said. "Please read the enclosed bulletin and take action today." A sense of urgency.

Then in smaller letters: "Learn about important 2023 Medicare Advantage options before the December 7 enrollment deadline."

Inside the envelope was another large black word, "BULLETIN," and instructions to "Call today to learn more" with instructions and a phone number.

However, the mailing did not come from the government or the Medicare program. There was also the name of an insurance company that sells Medicare Advantage HMO plans, different from standard Medicare. Many such plans are available; they are competitive and the marketing has been intense.

When I asked Norm Tetreault, a state health benefits counselor at Weymouth Elder Services, about it, he said, "Somebody else who wants your money."

Every year, people who qualify for Medicare health coverage have a chance to change their health plan if they find a different one with a better price or more coverage.

It is an important opportunity because, while your present Medicare plan may seem your best choice now, health insurance companies can change what they will cover and how much you have to pay every year.

Starting Jan. 1, the medical procedures, doctors and/or prescription medicines they will pay for and the premiums and deductibles may be different.

Advocates warn: What if your prescription drugs are no longer covered? Your doctor leaves the network? Your premium suddenly increases? Your co-payments jump?

A friend has been receiving near daily phone calls from insurance companies with HMO plans, called Medicare Advantage, urging her to enroll in their plan. She's fed up with being bombarded.

AARP and the National Council on Aging are urging all individuals with Medicare to evaluate their coverage during this year's open enrollment, which began Oct. 15 and runs through Dec. 7. Changes take effect Jan. 1.

It's easy to get confused or overwhelmed. So many choices, so much trouble sometimes getting a clear answer. Don't give up.

The state Office of Elder Affairs has valuable resources. The SHINE program (Serving Health Information Needs of Everyone) trains good, objective health benefits counselors who can help you for free at your local senior center. You just have to make a phone call to or drop by your council on aging and sign up.

You also can find more information on locating a counselor on the elder affairs website.

The regional SHINE director is Kathleen Chianca at HESSCO Elder Services. You can contact the HESSCO office to request to speak to a SHINE counselor there by calling 781-784-4944.

Norm Tetreault has been a SHINE counselor for 12 years. He volunteers at the Weymouth Senior Center along with two other counselors. They help people with any part of their Medicare coverage. Last year they received 230 requests for help on prescription plans alone.

"We are too busy to see everyone in person, but they can call, make a phone appointment, fill out a form with their basic Medicare information and submit it," Tetreault said. "Most of the questions we get are about the prescription drug coverage. Then we will do all the research and give them information on how different plans would cover or not cover the medications they take."

The SHINE counselors won't recommend a plan but will compare the cost, coverage and convenience of locations. They work with Medicare-eligible individuals as well as their families and caregivers.

If you miss this opportunity to make sure you still have the best deal, you will have to wait another year. Only about 10% of people use this chance to switch plans. They can end up overspending for coverage they don't need or use.

This year the stakes are especially high. Inflation is at a 40-year high. Federal rule changes make things more complicated. And Medicare has issued warnings about the marketing tactics of some Medicare Advantage organizations and brokers for prescription drug plans, Tetreault said.

There is good news. The Inflation Reduction Act will put new limits on prescription drug price increases, will cap monthly out-of-pocket costs for insulin at $35 and make vaccines free with no copay.

Be careful with the insulin price cap. To get the savings, diabetic Medicare beneficiaries first need to confirm that their insulin will be covered by their plan next year, warns the Senior Citizens League.

"If your insulin isn't covered by your plan, the $35 cap will not apply and you could wind up with thousands of dollars in pharmacy bills," says Mary Johnson, a policy analyst for the League.

For more information, visit the National Council on Aging at www.ncoa.org/Medicare and the Senior Citizens League at https://seniorsleague.org/week-ending-october-22-2022.

POKER UNLIMITED — The Duxbury Senior Center is offering a chance to get away from all this complicated health insurance lingo and join Sam Richardson, of Health Economics at Harvard University, for a three-week crash course in the most popular form of poker, "No Limit Texas Hold 'Em," at the senior center, 10 Mayflower St. The classes are from 10 to 11:30 a.m. Saturdays, Nov. 5, 12 and 19. The cost is $10 per class, $30 for the whole session. He promises probability, psychology, game theory and strategy. To register, go to duxburyseniorcenter.org or call 781-934-5774.

Reach Sue Scheible at sscheible@patriotledger.com.

A Good Age

Sue Scheible