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Medicare enrollment period offers a chance to shop for coverage, but many don't

Tom Constant, 61, St. Petersburg, who is diabetic, asked about prescription drug coverage during a recent seminar on Medicare enrollment at the St. Petersburg Main Library.
Tom Constant, 61, St. Petersburg, who is diabetic, asked about prescription drug coverage during a recent seminar on Medicare enrollment at the St. Petersburg Main Library.
Published Oct. 11, 2015

When it comes to guiding seniors through Medicare's annual open enrollment period, most experts sound a lot like Smokey Robinson and the Miracles.

Their oft-repeated advice: You better shop around.

"The open enrollment period is an opportunity to compare plans in a given area to be sure the drugs you take are still covered, and there are no surprise cost increases," said Tricia Neuman, Director of the Kaiser Family Foundation's Program on Medicare Policy.

Yet, many beneficiaries are reluctant to change their health or drug plans — even if means saving money.

Take William Szymanski, a 77-year-old retired newspaper production manager who lives in Bayonet Point. He laments the fact that the deductible on his prescription drug plan will increase from $70 to $350 next year. But he isn't ready to make a change.

"I've been with Blue Cross Blue Shield for more than 60 years," Szymanski said. "It's hard to just leave."

He and millions of other Medicare beneficiaries will decide whether to keep their plans for another year — or chose something different — when the open enrollment period begins Thursday.

The annual window for making changes ends Dec. 7.

Medicare is available to people who are 65 and older, as well as some people with disabilities. The health insurance plans cover more than 3.5 million Floridians.

Original Medicare covers hospital stays, doctor visits and other medical expenses. Beneficiaries can choose to add a prescription drug plan — or select an all-inclusive, privately managed Medicare Advantage plan instead.

Choices abound. Private insurance companies are offering 19 drug plans and more than 40 Medicare Advantage plans to enrollees in the Tampa Bay area for 2016, federal health records show. That's not to mention the host of supplemental policies, which pick up costs Original Medicare doesn't cover.

The already complex system is further muddied by the barrage of annual advertising from insurance companies. A recent report by the Kaiser Family Foundation found seniors felt inundated with information and "unqualified" to choose a plan.

"Many beneficiaries seek to make well-informed and financially sound decisions but do not feel confident in their ability to do so under the current system," the report concluded.

Marianne Ferrari, a retired executive and volunteer who leads free seminars on Medicare enrollment in St. Petersburg, said attendees often feel overwhelmed.

"People stay on their plan forever because they just don't know (what else to do)," she said.

There is some good news heading into 2016: On average, the premiums for Medicare Advantage and prescription drug plans won't change much, according to the Centers for Medicare and Medicaid Services.

But that doesn't mean the monthly costs or deductible won't go up for individual plans. Insurers can also change which drugs are covered, or which doctors are part of the network.

Ferrari says it is critical for all Medicare beneficiaries to examine their plans closely.

"You wouldn't want to find out that a drug you were paying $20 for in January is now $95, because that can happen," she said during a seminar last week at the St. Petersburg Main Library.

Dr. Kenyatta Lee, senior medical director of JSA Medical Group in Florida, pointed out that enrollees' medical conditions can change, too.

"You may have a new prescription for your diabetes that is different than what you had last year, and it may not be covered under (your old) plan," he said.

There are several ways to shop around. The Centers for Medicare and Medicaid operate an online "Plan Finder" (medicare.gov/find-a-plan), designed to help enrollees explore all of the drug and health plans available in their area.

Medicare also offers a help line (1-800-633-4227), as does the Florida Department of Elder Affairs (1-800-963-5337). The state offers free seminars and assistance through its SHINE (Serving Health Insurance Needs of Elders) Program, too.

Tom Constant, a retired critical care nurse from St. Petersburg, wants to see what other plans are out there. A diabetic, he was stunned when his Humana Gold Plus Medicare Advantage plan asked him to pay more than $600 for a 90-day supply of insulin earlier this year, he said.

"I'm trying to do my homework," he said. "I spoke to a nurse at my physician's office. They said I'd be better with Original Medicare and adding a prescription drug plan."

He plans to consult with a SHINE volunteer later this month.

Mary Mirk, a 69-year-old retired school nurse who lives in Tampa, is also exploring her options. The monthly premium for her Florida Blue drug plan increased, so she's considering a less expensive plan offered by UnitedHealthcare.

"I don't see why anyone would stay with it," she said of the old plan.

John Bassett, a retired public administrator who lives in St. Petersburg, will have to pay more for his Florida Blue Medicare Advantage plan in 2016. But he sees things differently.

"I've shopped around in previous years and I couldn't find anything that was really any better," he said. "Humana is the big one, but they have different doctors on their plans."

Though Bassett, 80, hasn't made a final decision, he's leaning in one direction.

"I'll probably stick with (my current plan)," he said. "I like the doctors I've got."

Contact Kathleen McGrory at kmcgrory@tampabay.com or (727) 893-8330. Follow @kmcgrory.

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