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COLUMN-You need a Medicare coverage checkup - and this is the time of year to do it

(The opinions expressed here are those of the author, a columnist for Reuters.)

CHICAGO, Nov 5 (Reuters) - Retirees, you might have missed it amid all the chaos we are enduring - but this is the time of year to re-evaluate your Medicare coverage. And what you may not know is this: you really need to do a checkup to make sure you have the best-fit coverage at the best price.

Medicare fall open enrollment season runs from Oct. 15 through Dec. 7 each year. For most enrollees, this is your only chance to reassess prescription drug or Advantage coverage. You also can switch between fee-for-service Original Medicare and Medicare Advantage, the all-in-one managed-care alternative to the traditional program.

If you have Original Medicare and a Medigap policy and are pleased with that coverage, leave it alone. But Part D drug plans often change their premiums and lists of covered drugs from year to year. A review of the 10 most popular Part D plans by Avalere Health found some plans with flat or barely changed average premiums for next year, but several are raising average premiums by double-digit percentages. Advantage plans can - and do - drop healthcare providers.

Reviewing coverage and shopping for new options does require some work. For next year, the average Medicare beneficiary will be able to choose among 33 Medicare Advantage plans - the largest number in the past decade, according to the Kaiser Family Foundation (KFF). The number of standalone Part D drug plans also is up a bit - the average beneficiary will have a choice of 30 standalone plans, KFF reports.

Start by reading the official Annual Notice of Change for your plan that Medicare sent to you in September (via mail or email). This document lists the changes in your current plan, such as the premium and copays, and will compare the benefits on offer for 2021 with those in 2020.

And do not focus your analysis solely on the premium, said Frederic Riccardi, president of the Medicare Rights Center. “Is the list of covered drugs changing next year? Will you have a higher copay?”

If you are enrolled in an Advantage plan this year, open enrollment offers the chance to move to Original Medicare, which offers access to a much wider array of healthcare providers compared with Advantage plan managed-care networks.

But there is an important caveat. The Original or Advantage decision is best made at the point of initial enrollment in Medicare. At that point, the program’s “guaranteed issue” rules forbid Medigap plans from rejecting you - or charging a higher premium - because of any pre-existing conditions. But after that time, Medigap plans in most states are permitted to reject your application or charge higher premiums (New York, Connecticut, Maine and Massachusetts all have some form of guaranteed issue rules for later Medigap enrollment)

During the annual fall enrollment period, you can shift to Original Medicare with a Medigap plan, but be sure to investigate whether you will be able to obtain supplemental coverage and at what cost. (reut.rs/329wCOE)

NEW ADVANTAGE FEATURES

Next year, Part D is adding a new program to help diabetic patients cope with insulin costs. Under the Senior Savings Model, participating Part D plans will charge no more than a $35 copayment per insulin prescription each month. Drug plans are not required to participate, but those that do can be found by using the Medicare Plan Finder to sort for insulin savings. Or contact a drug plan directly to learn if it is participating in this program.

Under legislation approved by Congress in 2018, Medicare Advantage plans now can pay for services designed to support older adults living at home with chronic conditions. The Chronic Care Act allows plans to pay for services such as grocery deliveries, caregiver support, and retrofitting homes. A small number of Advantage plans rolled out these services this year, and availability is expected to be limited in 2021, too.

MEDICARE AND THE PANDEMIC

Medicare is covering coronavirus-related testing, telehealth, and prescription refills.

Testing is covered under Part B; you pay nothing if you have Original Medicare and see a participating provider, or if you are enrolled in Advantage and see an in-network provider. If and when a vaccine is available, it will be covered under Part B with no cost-sharing.

Coverage of care provided through virtual telehealth services has been expanded dramatically during the pandemic, including hospital and doctors’ office visits, behavioral health counseling, and preventive health screenings. The usual cost-sharing applies, and if you are enrolled in Advantage, ask your plan provider about cost and coverage rules.

SHOPPING

Browse plans on the Medicare Plan Finder, the official government website that posts standalone prescription drug, Medicare Advantage, and Medigap offerings. (bit.ly/3emZTu2) The plan finder now allows users to sort plans not only by premiums but for total costs, including premiums, deductibles, copays and coinsurance payments.

When it comes time to enroll, call Medicare to sign up (1-800-MEDICARE) to ensure that your enrollment has been processed.

To learn more about Medicare enrollment this year, check out my recent podcast interview with Frederic Riccardi of the Medicare Rights Center. (bit.ly/3kTdwnv) (Writing by Mark Miller Editing by Matthew Lewis)

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