Medicare's open enrollment period, which includes the opportunity to enroll in Medicare Part D, ends today, Dec. 7. Many seniors don't know about the open enrollment period and don't realize they are locked into their health insurance for another year if they don't make changes.
Medicare Part D reduces federal spending by $12 billion by covering medications that are currently keeping seniors out of the emergency room. Medicare Part D gives more than 29 million Americans access to prescription drugs at prices they can afford. Before the creation of Medicare Part D in 2006, many treatments were too expensive for as much as a third of the elderly population. Without Medicare Part D, many seniors would have to forego such medications, in which case it's only a matter of time before they end up in the hospital, driving costs up for taxpayers.
In Utah alone, according to stats from 2008-09, there are 266,000 people on Medicare. Of those 266,000 people, 106,700 represent earnings less than 200 percent of the federal poverty level (28,400 at less than 100 percent; 39,400 at 100-149 percent; and 38,900 at 150-199 percent).
While navigating the Medicare open enrollment process can be complicated, there are specific things people can investigate to see whether their insurance is still suitable for their needs – before they are locked into another year with that insurance company.
Ensure your physicians are still covered by your insurance. If they're no longer in your network, you'll have to pay out-of-pocket to continue seeing that physician if you keep your current insurance plan.
Check that your prescription medicines are still covered — and at the same price. This should be done every year, as insurance companies regularly change their list of medicines covered. From time to time, they may also choose to classify a drug in a higher tier, which means higher co-pays for the patient.
Add up co-pay and deductible payments as well as other out-of-pocket expenses you'll be responsible for. Doing this ahead of time will ensure you know exactly how much you'll be paying for your health insurance plan.
Note which prescriptions require prior authorization or step therapy. Prior authorization policies require the physician or pharmacy to obtain authorization from the insurance company before the prescription can be given to the patient at a co-pay rate. Not all prescriptions are approved by insurance companies, and patients may have to pay out-of-pocket to be able to take the prescription their physician prescribed. Step therapy (or "fail first") policies require patients to try cheaper medications before they are authorized to take preferred medications that cost more.
Read the fine print. Understanding all the details of each plan will help ensure there are no unpleasant surprises down the road. If there are, you will know your rights and have an idea of how to proceed from there. If any part of your plan is unclear, ask for clarification.
Your health care is important, and it's critical you have a health care plan best suited to your unique needs.
Jeanetta Williams serves as president of the NAACP Salt Lake Branch and Tri-State Conference for Idaho, Nevada and Utah. She is a former member of the NAACP National Board of Directors.