Seniors should review their options every year to ensure optimum coverage

MECOSTA/OSCEOLA COUNTIES — More than the leaves are changing this fall, and seniors need to be aware their Medicare coverage needs a review during each open enrollment period.

Open enrollment, which runs from Oct. 15 to Dec. 7, is the period of time each year when Medicare recipients — of all ages — can review what each plan will offer in the coming year and sign up for the one that best meets their needs.

“Every plan changes every year,” said Scott Schryer, director of the Osceola County Commission on Aging. “Just because your plan worked for you this year does not mean it’s going to work well for you next year.”

Plans change each year because many of them are administered by private insurance companies that are trying to maximize their profits, said Linda Stricker, a Medicare Medicaid Assistance Program volunteer counselor who sees clients at the Mecosta County Commission on Aging.

“Some changes are to meet federal regulations about how drugs are managed, but a lot of the changes have to do with costs,” Stricker said.

The time to review coverages and make selections is during open enrollment, because once that window closes, it won’t open again for a year.

“Come the first of the year, when you go buy your meds the first time and you get that first great big bill because you’re on the wrong plan, there’s nothing we can do,” Schryer said. “It’s heartbreaking. The stories of what happens to people are terrible — and there’s just nothing we can do at that point.”

Medicare has four parts, and each section covers something different. Medicare Part A is hospital insurance and covers in-patient costs in hospitals and skilled nursing facilities. Part B is medical insurance, and covers doctors’ services, outpatient care, medical supplies and preventative services. Part C, also known as Medicare Advantage Plans, are plans offered by private companies that contract with Medicare to provide Part A and B benefits. Medicare Part D is prescription drug coverage.

Seniors eligible for the program can choose to receive their coverage in two ways, as stated on medicare.gov, the official site for Medicare: “There are 2 main ways to get your Medicare coverage — Original Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). Some people get additional coverage, like Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap).”

When selecting coverage, seniors need to make sure the medicines they take are covered under the plan they select, Schryer said. For example, the Medicare option they chose last year may have covered all generic prescriptions for free, but next year the same plan won’t do that — but another one will.

“There are certain people we put every year into a new plan, but every year their medicine is covered because they’re on generics,” he said. “Then there’s the other side, people with cancer or insulin-type meds, which are not covered under Medicare very well at all. A lot of times, we’ll find a plan for somebody but then call the drug company directly and ask if we can get them free samples or get them signed up on a program. Each drug company has programs where people can sign up for free medicine for a year, because they have to give back so much each year.”

Assistance determining which plan is the best fit for a particular senior’s needs is available. The Commission on Aging in both Osceola and Mecosta counties has at least one Medicare Medicaid Assistance Program volunteer.

“The MMAP counselors are all trained through the Area Agency on Aging and if any COA has one, they’ve been properly trained and are running under the Area Agency umbrella as volunteers,” Schryer said. “If someone lived in a county with a COA, they could call the Area Agency on Aging of Western Michigan directly to find out where the closest counselor is — not every MMAP counselor works at a COA.”

The Medicare program is set up for seniors to view their options and make their enrollment decisions independently, but it fails to consider the varying needs of some older Americans, he noted.

“The federal government didn’t take into account the layers of dementia and layers of non-technical Medicare users in the population,” Schryer said.

MMAP counselors help seniors who don’t have or aren’t comfortable working with computers, because plan comparisons, as well as signing up for a particular plan, are done online at medicare.gov.

“The biggest thing we do is helping people to compare plans – to do that comparison, you need to go online to medicare.gov,” Stricker said. “There, they have the plan-finder, which breaks the options down by where people live, what pharmacy they like to use, and what medications they take.”

Anyone in Mecosta County seeking assistance with their Medicare plan selection can call the Mecosta County Commission on Aging at (231) 972-2884. Residents of Osceola County can call the Osceola County Commission on Aging at (231) 734-5559.

Medicare recipients also call call the Area Agency on Aging of Western Michigan at 1-800-803-7174, email their question to aaainfo@aaawm.org or visit medicare.gov.