Health Column: Can I change my Medicare health coverage after Jan. 1?

01/03/2011 11:11 AM |

Dear Marci,
My sister and both of my parents have had glaucoma, and my doctor thinks I should get screened. Will Medicare pay for it?
Clayton

Dear Clayton,
Yes. Medicare covers 80 percent of the cost of an annual glaucoma screening if you are at high risk for glaucoma, after you pay your annual Part B deductible. The screening must be performed or supervised by an eye doctor who is licensed to provide this service in your state.
If you are in a Medicare private health plan, you should contact your plan to see what rules and costs apply.
In addition to people with a family history of glaucoma, those at high risk for the disease include people with diabetes or high blood pressure, African-Americans age 50 and older and Hispanic-Americans age 65 and older.

Dear Marci,
Can I change my Medicare health coverage after January 1?
Alma

Dear Alma,
Not necessarily. It depends on what your current coverage is and how you want to change it. Starting in 2011, there will be a Medicare Advantage Disenrollment Period, which will run from Jan. 1 through Feb. 14. The Open Enrollment Period, which ran from Jan. 1 through March 31 in past years, no longer exists. Changes that you make during the MADP go into effect the first day of the following month.
During the MADP, you can make changes only if you have a Medicare private health plan. Medicare private health plans are also known as Medicare Advantage plans. You can usually add or drop drug coverage when you are switching to Original Medicare. You can’t make any changes if you have Original Medicare.
If you disenroll from your Medicare private health plan (Medicare Advantage), federal law does not give you the right to buy a Medigap plan. The laws in your state may give you more rights and allow you to enroll in a Medigap plan. Medigap plans are supplemental policies that help pay for Original Medicare deductibles and coinsurances. You should check with your State Health Insurance Assistance Program to find out if and when you can enroll in a Medigap plan in your state. You can find the number for your local SHIP by visiting www.shiptalk.org or calling 1-800-MEDICARE.

Dear Marci,
I have Extra Help, which helps pay for my prescription drugs. Will my co-pays ever change throughout the year?
Joan

Dear Joan,
They may. With Extra Help, you will always pay either your Extra Help co-payment or the amount that your plan charges people without Extra Help, whichever is cheaper. However, since the amount a plan charges its members for prescriptions can change throughout the year, the “cheaper” amount may vary over time.
Your out-of-pocket costs will also change once you reach catastrophic coverage. If you have Extra Help you will reach catastrophic coverage after your total drug costs — what you have paid plus what your plan and what Extra Help have paid for covered drugs — reach $6,448.
Once you reach catastrophic coverage, if you have full Extra Help, you will pay nothing for drugs on your plan’s formulary for the rest of the calendar year. If you have partial Extra Help and have been paying 15 percent of the cost of your drugs or your plan’s standard co-pay or coinsurance, (whichever is cheaper), you will pay $2.50 for generic drugs and $6.30 for brand-name drugs for the rest of the calendar year.

Marci’s Medicare Answers is a service of the Medicare Rights Center, the nation’s largest independent source of information and assistance for people with Medicare.

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