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Was your open enrollment review good, bad or ugly?

Happy Holidays! I hope everyone’s preparations for family and friends this holiday season is going well. There’s a lot of things going on this time of year to keep us all busy.  As I mentioned in my last blog, one of the most important year end tasks is reviewing your Medicare insurance coverage, including your Part D prescription drug plan.  Because I moved to a different state it was especially important that I reviewed my coverage and in doing so I had some interesting experiences and some money saving discoveries.  I think by going through some of the decisions and tradeoffs I had to make, they might help us all better understand the policies and regulations that are in place now or how the changes that are being considered by our leaders in Washington might affect each one of us.

As I mentioned I moved to a different state and that move gave me some broader choices.  Previously, I had a supplemental insurance plan and a stand-alone Part D plan.  The availability of Medicare Advantage plans in my old state were limited so a supplemental plan was the best choice for my wife and myself.  In my new state I had the choice of various Medicare supplemental plans, but I also had the choice of five different Medicare Advantage plans.  Since the premiums are often less or zero with Medicare Advantage, I was very interested in what these five plans had to offer.  Here are just a few things that I had to consider when looking at the Medicare Advantage plans offered in my state:

  • Were my new doctors in the PPOs?
  • What doctors were part of the HMOs?
  • What would my new premiums be?
  • What were the copays for an office visit to my primary care doctor?
  • What were the copays for an office visit to specialists?
  • What was the copay for a visit to the emergency room?
  • Did the plan include Part D, if so, did it cover the prescription drugs that we currently use?
  • What were the copays on the medication?
  • Was any medication on specialty tiers?
  • Was coinsurance part of the plan, if so, what was the percentage? 
  • What was the yearly out-of-pocket maximum for health services?
  • Did the plan include dental, hearing, eyesight or other benefits (like silver sneakers)?

There was a lot to consider and a lot of acronyms and terms that I had to understand.  It was no small task and took considerable time.  It was a little easier given I’ve been involved in health care policy for over 20 years, but it was still time consuming and arduous at times.  After I had made my preliminary decision, I used another resource that was available to me as a military veteran.  When I first joined the Air Force, I had the opportunity to use USAA for my car insurance.  I’ve gone on to use them for other insurance and financial needs and they offer a phone number and assistance for choosing insurance plans.  I’m not selling USAA products, I don’t sell anything on this blog, but I want to remind you that you should research all the resources available to you and take advantage of any help available.  I did and was very pleased with the help and advice I got from the USAA person.

In the end I chose a Medicare Advantage PPO plan and found that I saved a large amount of money on premiums.  I had to balance that with an increase in my yearly out-of-pocket maximum and some higher copays.  I’ll have to see what kind of care I receive, but on balance I think I will be better off.

I hope you are satisfied with your insurance or made a change during this open enrollment period that will give you better benefits or cost less.  As I’ve said before this blog will focus on you, the consumer and the impact that regulations and legislation will have on your access and cost.  Health care is complicated, you probably had that driven home as you reviewed your coverage.  I will work to try to simplify the Washington rhetoric and boil things down to show how their proposals and solutions will affect you. As part of this endeavor my next blog will define some of the terms that are used in health care insurance, regulations and legislation.  My definitions will focus on how these different items affect you and your level of care or pocketbook.  Ever wonder what the difference is between copay and coinsurance?  Watch for my next blog, that will strive to demystify this complicated thing we call health care.