If you are enrolled in Medicare, now is a good time to review your health and prescription drug coverage, due to changes in the program mandated by the recent federal health care reform legislation.
For 2011, you may switch Medicare Advantage health or prescription drug plans only once between Nov. 15 and Dec. 31, 2010. Your new coverage then begins on Jan. 1.
After this enrollment period, the only change you can make for 2011 is to move from Medicare Advantage to Original Medicare — and only from Jan. 1 to Feb. 15.
Making the right choice of a Medicare plan offers a pretty big payoff: a longer, healthier and less-stressful life.
Things to consider in making your Medicare plan choice:
» Think about your changing health care needs and how these may or may not be covered by a particular plan.
If you’re managing a chronic condition, such as diabetes or heart disease, make sure that your 2011 coverage will keep pace with your needs in coping with those conditions. Will multiple visits to a primary care physician or specialist be covered? How about classes, support groups or the ability to see alternative practitioners?
» Consider what you want from your physician and providers.
Once you’ve assessed your particular health care needs for the coming year, evaluate a plan’s care delivery service and network of providers and how they might work with your lifestyle and specific needs.
Do you like the idea of having a large network of physicians, specialists and hospitals?
Would having all your appointments, including lab work and X-rays, in one physical location be attractive?
Do you prefer a Health Maintenance Organization or a Preferred Provider Organization? There are benefits to both types of plans. Know the differences and how they can affect your access to care.
» Determine whether your past health care experiences will meet your future needs. Did anything change this year; what changes would you like to make for 2011?
For example, you may be setting new health goals such as losing weight or better managing cholesterol. Does a plan provide classes or online tools to help meet those new goals?
» Determine which online support tools are important to you. Also, determine what a health plan offers in terms of Internet-based support and resources. The ability to access health information, contact your doctor and obtain test results from home can be invaluable, particularly if a health condition affects mobility.
» Ask for help in understanding anything that is unclear. There are changes in Medicare every year. Fortunately, there are many resources, including the government’s website, www.Medicare.gov, which allows you to enroll online.
Kaiser Permanente also provides a website, www.kp.org/ medicare, where one can learn about Medicare, explore health plans and enroll online in a Kaiser Permanente plan.
» Consider all health care costs and services before selecting a plan.
It may be tempting to sign up for the plan with the lowest premium, but look at the total value in terms of service and costs.
How much was spent on your health care costs last year, including premiums, deductibles and co-pays?
Then, examine your options for the coming year. Does the plan offer classes, seminars or online resources? How accessible are your physicians? What is the deductible and out-of-pocket maximum for each plan?
Sheri Oishi is director of Medicare and Medicaid for Kaiser Permanente Hawaii.