Medicare enrollment starts Sunday: Here's what you should do

2017-10-12 | Asbury Park Press

Oct. 12--FREEHOLD TOWNSHIP -- To Goozmer, 78, it is overwhelming, so she sticks with her tried-and-true Medicare Advantage plan from UnitedHealthcare.

"It's too complicated," Goozmer said. "I hardly understand what they send me with the letters. They keep sending me letters, switch, don't switch. I have to call them and ask them, and they tell me go onto the internet. That's even worse."

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Medicare's open enrollment begins on Sunday and lasts until Dec. 7, giving seniors age 65 and older a chance to review and select their health insurance coverage for 2018.

While Obamacare remains under political attack, Medicare is hugely popular, with an approval rating of 75 percent. Not that it doesn't have complaints; physician networks are getting tighter, and drug prices are soaring. But consumers who are unhappy will have options this enrollment season, one expert said.

"This year, there's a lot more stability in our marketplace, which is welcome," said Derick Buckley, owner of the Buckley Insurance Group in Brick.

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Huge numbers

Medicare has largely escaped the headlines since the Patient Protection and Affordable Care Act, or Obamacare, passed in 2010, but its impact on the health care system is big.

It covers 1.5 million New Jerseyans, or 15 percent of the market. By comparison, Obamacare's individual market and expansion of Medicaid covers about 839,000 consumers statewide.

Medicare customers have largely escaped changes brought by the ACA. But Buckley said it's not easy to convince them; his phone often rings with clients worried their plans are tied to the latest Obamacare headlines.

His response: "People in Medicare, they're in good shape right now," he said.

What do you need to know for 2018?

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1. The basics

Medicare consists of Part A, which covers hospital care; Part B, which covers services such as doctor visits and lab tests; and Part D, which covers prescription drugs.

* A. Most people don't pay a premium for Part A and have a deductible for inpatient care of $1,316 for the first 60 days.

* B. Their premium for Part B this year varies based on income. For example, married couples making $170,000 or less this year face $134 a month. Married couples making more than $428,000 paid $428.60 a month. Premiums are automatically deducted from Social Security payments. And the amount for 2018 has yet to be announced. Their Part B deductible is $183. They pay 20 percent of the cost after that, which often prompts them to buy a supplemental plan to fill in the gap.

* D. Their premium for Part D this year also ranged from nothing for married couples making $170,000 or less to $76.20 for married couples with income of more than $214,000. Some drug plans have deductibles of up to $405. The plans also typically have co-payments. Consumers using generic drugs pay less out of pocket.

2. What happened to C?

The Medicare program also has Part C, which is a term for Medicare Advantage, plans offered by private insurers that are approved by Medicare.

Monmouth and Ocean County residents can choose plans from Aetna, Clover Health, Horizon Blue Cross Blue Shield of New Jersey or UnitedHealthcare.

While a third of Medicare beneficiaries nationwide are covered by Advantage plans, New Jersey has been slower to adapt. But that might be changing. Some 21 percent of New Jerseyans were enrolled in Advantage plans this year, compared with 16 percent last year, according to Kaiser Family Foundation.

It's a sign that fewer retirees are being covered by their former employers, said Julie Mascari, head of strategy, product and marketing for Horizon's Medicare Advantage products.

Horizon is trying to make inroads at the Jersey Shore. It introduced a plan that has no monthly premium.

The trade off: Unlike traditional Medicare plans that allow consumers to visit any provider, Medicare Advantage plans typically have tighter networks. In Horizon's case: doctors affiliated with Hackensack Meridian Health or RWJBarnabas Health.

"We decided that Medicare Advantage is an environment and space we absolutely want to be in," Mascari said.

3. Not all a bed of roses

Consumers thinking about enrolling in Medicare Advantage should check first to make sure their doctors are in the plan's network.

But even then, it doesn't protect Medicare beneficiaries from changes roiling through the health care industry.

With so many choices, Goozmer sticks with UnitedHealthcare. The plan includes her doctors, and it helps pay for a membership at CentraState Fitness Wellness Center in Freehold Township, where she visits four or five times a week.

But she has noticed changes, too. The price of her brand-name heart medication skyrocketed. And she once had access to her cardiologist, but she now usually sees a physician assistant instead.

In that respect, Medicare and non-Medicare consumers aren't so different, after all.

"The P.A. is very, very nice, don't get me wrong, but it's not the doctor," she said. "That's what's going on now."

Michael L. Diamond; 732-643-4038; mdiamond@gannettnj.com