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Dec. 7, not Tuesday, is D-Day for Medicare beneficiaries

Deadline nears for making changes to Medicare drug, health plans
by Paula Burkes Published: November 5, 2012

With the presidential election two days away, David Adamson, of Oklahoma City, is worried about losing the comprehensive health insurance he and his wife have under AARP's Secure Horizons Medicare Advantage plan.

“If it's axed,” he said, “we figure we'd have to pay an extra $450 a month for supplemental insurance and prescription drug plans. And to us seniors, that's a real fear.”

Across town, Sharon Beasley, of Newcastle, rues the day in May she turned 65.

“I find health insurance with Medicare even more mind-boggling than before we got old,” said Beasley, who unsuccessfully tried to make sense of the Medicare payments for her husband's hip surgery a few years ago.

“Talk about the runaround,” Beasley said. “Each entity referred me to another. I finally gave up and hoped no one was padding the bill.”

Though Beasley and other Medicare recipients understandably have questions about Medicare's future, they should be more focused on Dec. 7 than the election Nov. 6, say officials with the Oklahoma Insurance Department.

Dec. 7 is the deadline for Medicare beneficiaries to change drug or health plans for next year, said Ray Walker, director of the department's free Medicare Assistance Program. If seniors don't make changes by then, most will be locked into their drug or health plans for another year, he said.

Walker strongly recommends seniors every year seek counseling on Medicare Part D, which covers prescription drugs through private insurance companies. Insurers can change the drugs they cover from year to year, and a plan's rate and cost structure can go up annually, Walker said.

By entering beneficiaries' medications, ZIP codes, age and other information in search engines on, counselors can help seniors find the most cost-effective and best plans, Walker said.

“One of our volunteers in Marietta, who's a retired CPA, found beneficiaries on average save $300 by changing plans annually,” he said. Walker said he saved his uncle $7,000 by moving him from a plan that didn't cover his costliest medication to a plan that did.

Though most seniors in Oklahoma who carry drug plans choose Part D Medicare insurance, nearly 16 percent of the 626,000 Medicare beneficiaries in Oklahoma, or some 100,000, opt for Medicare Advantage network plans that include prescription drug coverage, Walker said.

During this annual election period, counselors can help seniors pick up or drop a Medicare Advantage plan or switch to a new one, he said.

“Seniors in rural areas should be particularly cautious about agents selling them Medicare Advantage plans,” Walker said. “Many plans may not have hospitals or physicians located within their community, and traveling to Oklahoma City or Tulsa would be inconvenient or impossible for them.”

Several providers of Medicare Advantage plans have dropped service in certain areas, though some seniors on those plans still may be unaware they no longer have coverage, Walker said.

“Plan participants were sent notices in September, but many may have just opened that piece of mail,” he said, “or only recently heard from a friend that their plan is going away.”

Walker said Windsor Sterling had the largest reduction, which affected 3,540 beneficiaries from 59 counties across the state, including 724 beneficiaries in Tulsa County and 392 in Oklahoma County. Meanwhile, Ardent, which operates the Lovelace Medicare Plan HMO in Oklahoma, reduced its service area, affecting beneficiaries in Oklahoma, Mayes and Payne counties and a reduction by Humana affected 690 residents in Creek County.

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by Paula Burkes
A 1981 journalism graduate of Oklahoma State University, Paula Burkes has more than 30 years experience writing and editing award-winning material for newspapers and healthcare, educational and telecommunications institutions in Tulsa, Oklahoma...
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Medicare election period closing

• Dec. 7 is the deadline for Medicare beneficiaries to change drug or health plans. New elections will take effect Jan. 1.

• For free counseling to make sure you're on the right plan, call the Medicare Assistance Program at the Oklahoma Insurance Department at (800) 763-2828, from 8 a.m. to 5 p.m. weekdays. Counselors can answer questions or set appointments for their office at 3625 NW 56, Suite 100. If you live outside the metro area and you'd like free face-to-face counseling in your local area, Medicare Assistance counselors can connect you to a qualified agency such as the Area Agencies on Aging or the Community Action Agencies.

Extra Help/Low-Income Subsidy

• Seniors with monthly incomes up to $1,225.13 ($1,654.88 for married couples) and up to $8,180 in assets which don't include their home and the vehicle they drive, ($13,020 for married couples) may qualify for full extra help from Medicare to pay prescription costs. For those who qualify, their monthly premium is covered and their copay will be no more than $2.60 for each generic/$6.50 for each brand-name covered drug. Partial extra help is also available for those who make slightly more.

SOURCE: Oklahoma Insurance Department and The Center on Budget and Policy Priorities


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