Your Insurance . . . with Michele Campbell: It’s open enrollment, time to consider changes to your health plans

There are now about 15 Medicare Advantage plan choices in Santa Clara County

By Michele Campbell

Open enrollment has started and there is a lot of activity happening around this season. This is Gilroy residents’ window to make a change to their health plan for their Medicare and Individual coverage.  You have until Dec. 7 for Medicare, to change your plan, for a Jan. 1, 2019 effective date. The Individual Open Enrollment Period runs through Jan. 15. If you want to make a change for Jan. 1, you must make your change by Dec. 15.

Several new Medicare Advantage (HMO) plans have come to town this year. There are now about 15 Medicare Advantage plan choices in Santa Clara County alone. So how does one compare plans to know which one is best for them? It first starts with your doctor, or should I say the network of doctors.

With an HMO plan, you have to pick a Primary Care Physician (PCP) first, from the choices available for that plan, then your specialists will have to be in the same network as the PCP. You must stay in network for all your services and get referrals for specialists. You have urgent care and emergency coverage when you’re out of network, anywhere in this country, and some even have worldwide coverage.

These days, these Medicare Advantage plans are getting quite competitive, adding many extra benefits to their plans such as giving you a specific dollar amount to spend for over the counter items (first aid items, cough and cold remedies, and pretty much most items in the pharmacy department of a drug store); transportation rides; gym membership; personal emergency response system; vision; dental; etc. These plans are typically cheaper in the monthly premium you pay the insurance company, and then you could have copays for the different services you use. Every plan is very different in this area.

If you’re on Medicare, this is an important time to review your Medicare Advantage plan and/or drug plan, to be sure it is still the best plan for you. Drug plans (Part D) change from year to year, some plans go away, new plans come, the drugs that are covered can change, etc. In California, we now have 32 Part D drug plans to choose from. That’s a lot of plans and you may need help deciding which is best for you.

If you’re on a Medicare Supplement plan, this doesn’t ever change for you, or at least the benefits don’t.  The premium typically goes up each year, as you age and if they have an increase in your plan. If you feel like you’re paying too much, you might want to do a plan review.

Many folks feel overwhelmed with all these choices and are confused on what to do or how to research plans. We hear this all the time, that they just don’t like dealing with insurance.  Not to worry, you’re not alone. You don’t necessarily have to do anything, however, this is the time to analyze your plan, especially your drug plan, to be sure your medications are covered well and will save you the most money.

One way to analyze your medications is to go to Medicare.gov and create an account. You can enter all your medications, then choose the pharmacy you prefer, then see how your prescription drugs are covered.  This can be daunting from some people.  If this is you, then you should contact an agent to help you. There are agents out there, waiting to assist you.

We can help put your mind at ease and our services are free.