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Guest column | Diana C. Brijbag

Time to shop for right Medicare plan

It's that time of the year when there is confusion and misunderstanding, which makes for interesting conversation at the bingo club, outside church gatherings and/or local group meetings. As an advocate for the elderly, please allow me to offer my two cents worth.

Which Medicare Advantage Plan is better than the next? What do I need to look for? Am I happy with what I currently have and do I want to stay on with my doctor?

If your answer is yes to the last two questions, just move on. Don't confuse yourself or add any more stress to the level you may already have given yourself last year.

So, if you are not happy, or need to make a new decision, let's review some plans and what they can do for you. I cannot tell you what to buy, but I can tell you how to shop.

Many Medicare Advantage Plans have turned into capitation. This means you are very restricted to stick with what they are presenting to you. Ask about capitation and let them explain the difference to you. Who makes the money? The top guys of course, not your doctor. Your doctor gets paid a monthly fee and their office is soon to be a clinic with many long hours of waiting.

How many prescription drugs are you taking? Are they covered? Do you pay a co-payment? What tier do they fall under? Is it a mail order, and what about the doughnut hole/coverage gap? Should you stay with your old traditional Medicare plan and just shop for a standalone prescription drug plan? If you decide to go that route, your premium would be the same or less than their coverage in 2008, if you enrolled for this in 2009.

I would suggest reviewing how these plans are changing and what other options are available to determine which plan best meets your needs.

You will have access to at least one prescription drug plan with premiums of less than $20 a month if you qualify for the full Medicare subsidy plan with no premium or deductible.

Read all the newspaper ads and go to a presentation. When you go, ask your entire question over and over again, until you understand what you are getting into, and avoid the phone calls afterward, which can constitute harassment.

Many doctors' offices require a contract with any of these private fee-for-service plans, so they can negotiate a contract. They are mostly offered by Blue Cross Blue Shield, Humana, United Healthcare, Today's Options, Physician United Plan, Evolutions, Adventure Freedom Coventry, Preferred Care, Sterling Options, etc. These are private plans that offer a great package, including vision and dental care.

Last year, I wrote an article called Your free lunch was not free at all. Well, I guess it worked. No more free luncheon, but education one-on-one discussion.

My last suggestions: Attend local seminars, search the Web, make your own phone calls, stay happy, network with your fellow citizens. After all, it is only health care.

Diana C. Brijbag of Brooksville is an office manager at a medical practice and a nationally certified medical manager.

Time to shop for right Medicare plan 12/03/08 [Last modified: Thursday, November 4, 2010 10:50am]
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