Health Column: Time to pick a Medicare plan

10/04/2011 5:07 PM |

Dear Marci,
I just received a letter in the mail labeled ‘Annual Notice of Change.’ What is this?
Riley

Dear Riley,
The Annual Notice of Change is a notice your Medicare Advantage plan or Medicare Prescription Drug plan sends you every year. The notice explains how your plan’s coverage and costs are changing for next year. Your plan must make sure you get your notice in the mail by Sept. 30. It’s very important that you read your notice and consider all your options, since many plans make changes every year and your current plan may not be your best choice for 2012. Your notice comes at the end of September so you can determine whether it is best to keep or change your plan for next year during the fall open enrollment period between Oct. 15 and Dec. 7.

When you review your notice, pay particular attention to the summary of the new formulary for covered drugs. The plan’s formulary may have changed for next year and new restrictions may have been added. Be sure the new formulary still allows you to get the drugs you need. If you do not see one or more of your drugs on the summarized formulary, call your plan or check its website for a full list of covered drugs and, if necessary, consider switching to another drug plan.

You should also review the notice for consolidations and terminations. Plans from the same company that offer nearly identical benefits continue to be consolidated to help simplify the choices available to consumers. If your plan is consolidated with other plans, you will automatically be enrolled in a plan from the same company that has benefits most like those you had. Even though you will automatically be enrolled in another plan, you have the right to choose and enroll in a different plan during the fall open enrollment period.

Terminated plans no longer participate in Medicare. If your plan has been terminated, you can use the open enrollment period to enroll in a new one. In this case, you are also entitled to a longer enrollment period that lasts through Feb. 29, 2012, to find a new plan.

Dear Marci,
Will Medicare cover counseling to help me quit smoking?
Toni

Dear Toni,
Yes, Medicare covers counseling to help you quit smoking.

Medicare covers counseling for two attempts to quit smoking per year. Each attempt includes four sessions, which comes to eight sessions every 12 months. You can receive counseling at a clinic, the outpatient department of a hospital or a doctor’s office — including offices of physicians, psychologists or clinical social workers. A doctor or an approved Medicare provider must perform the counseling.

If you have Original Medicare, you no longer pay coinsurances or deductibles for smoking cessation counseling if you have not been diagnosed with an illness that is caused or complicated by smoking, and if you see a Medicare-recognized doctor or other health care provider. Medicare also covers smoking cessation counseling for people with Medicare who have been diagnosed with a disease or condition caused or aggravated by smoking. In this case, Medicare will pay 80 percent of the approved amount for smoking cessation counseling, after you meet your Part B deductible.

If you are in a Medicare Advantage private plan, contact your plan to see what rules and costs apply. Starting in 2012, Medicare Advantage plans can’t charge you for preventive services that don’t have cost-sharing under original Medicare.

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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