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Insurance companies have filed their modifications and benefits with Centers for Medicare Services for the year 2009 for Medicare Part D Prescription Drug Plans, Medicare Advantage Plans, and Medicare Choice Plans.  Around October 15^th, this information will be released and can be viewed on medicare.gov and of course Medicare Annual Election begins November 15^th and runs to December 31^st.  With this in mind, Medicare beneficiaries need to begin thinking about how this may affect them and to reflect upon coverage in 2008.  Here are just a couple of points to consider:

1)      Medical Inflation – with medical inflation varying amongst areas and segments between 5-10% a year, you can bet you will see higher costs.  Many Medicare beneficiaries only look at the price of the plan to determine if their plan is cost efficient.  However, plans have several ways of increasing costs such as increasing co-pays (such as doctor office co-pays going from $15 to $20), increasing coinsurance for certain benefits, excluding certain procedures, limiting your network to certain areas, or even increasing your maximum out of pocket costs.  All these factors should be evaluated in determining if you plan is still the most cost effective for you.

2)      Part D Medicare Prescription Drug Plans – with several insurance companies indicating losses on their Part D prescription drug plans, this is one part of Medicare you will want to hone in on. Rumblings have been heard that we will see significant increases in the Part D this year – not only in premium but in co-pays amongst the different levels of drugs such as generics, preferred brand name, and non-preferred brand name.  Also, you will want to make sure your prescription drugs are still within the formulary of the plan.  The only way to ensure you are in the most cost efficient Medicare prescription drug plan is to run your personalized list of prescriptions through medicare.gov.  It will rank your unique list of prescriptions amongst different plans in order of most cost efficient to least cost efficient.

3)      Run all scenarios – many Medicare Beneficiaries don’t look at their options separately.  Yes, you can have a separate Part D Prescription Drug Plan with one insurance company with a Medicare Advantage Plan or Medicare Choice Plan with a different one.  Yes, you may look at a Medicare Supplement versus a Medicare Advantage Plan and you should evaluate this annually.  Rarely, do you see one insurance company solve everyone’s medical and prescription drug needs every single year.

4)      Physician Acceptance – let’s face it, Mesa County is far different than our Delta sister county to the south.  Many of their clinics are considered rural based and therefore get higher subsidization and therefore have to accept all insurance carriers.  Not so in Mesa County - here we are home to a Medicare Choice Contract with Rocky Mountain HMO that will be up for Federal review in 2010.  This competes against Medicare Advantage Plans as they pay doctors a higher reimbursement above the Medicare Assignment Rate whereas Medicare Advantage Plans pay the physicians 100% of the Medicare assignment rate.  Even though they are both federally subsidized programs, the different reimbursement rates cause insurance discrimination amongst these two programs.  Last year this was particularly the case with Primary Care Partners and Dr. Vincient, as they restricted their Medicare beneficiary patients to just RMHMO or original Medicare with a Medicare supplement.  It will be advisable again to make sure your physician will bill and/or accept your plan of insurance.

These are just a few of many suggestions to consider when you are evaluating Medicare options.  As 2009 information is released - utilize medicare.gov, contact your local SHIP office, or work with an insurance agency that represents multiple insurance companies to evaluate all your options.