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Open enrollment gives Medicare users a choice

If you’re on Medicare and are thinking about making changes to your health plan, the clock is ticking.

Open enrollment for Medicare runs until Dec. 7. Any changes will take effect in January.

“Open enrollment is the best time to make sure your health and drug plans still meet your individual needs, especially if you’ve had any changes in your health,” said Bob Moos, spokesman for the Centers for Medicare & Medicaid Services.

“We’re seeing changes in the costs that plans charge, both for their coverage and specific drugs, so it’s really important for people to take the opportunity during the open enrollment period to look at the coverage that they have now,” said Juliette Cubanski of the Kaiser Family Foundation, a nonprofit that focuses on health issues.

Next year’s standard Medicare Part B monthly premium, at $104.90, and annual deductible, at $147, will remain the same as the last two years. Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment and other items.

About 49 million Americans are enrolled in Medicare Part B.

For the small number of beneficiaries who pay Medicare Part A monthly premiums, their bill will drop $19 in 2015 to $407. Medicare Part A covers inpatient hospital, skilled nursing facility and some home health care services.

The average monthly premiums for Medicare Advantage plans will increase by $1.29 to $32.25, while the average monthly premiums for basic drug plans will rise $1.32 to $32, Moos said.

Advantage plans are essentially a private version of Medicare. Instead of paying beneficiaries’ claims directly, the government pays insurance companies to oversee the health care of seniors and people with disabilities.

The plans have become popular with seniors on fixed incomes because they typically combine hospital and physician coverage with additional benefits, such as prescription drug insurance, preventive medical care, dental services and vision coverage.

However, Advantage plans have limited networks of health care providers, and doctors can drop out midyear.

Nevertheless, enrollment in the private Medicare Advantage plans is expected to grow by about a half-million to 16.1 million people in 2015 – about 30 percent of Medicare beneficiaries.

Even if you’ve been satisfied with your health and drug coverage, you may benefit from reviewing your options. Shopping around may save you money or improve your coverage.

Don’t shop just on premiums alone.

“The only way to determine the true cost of your drug coverage is to consider other factors like deductibles, co-payments and coinsurance,” Moos said.

Also, look at your individual drug needs.

“For every given individual, their experience will be different than the average,” Cubanski said. “It’s best for people to look at their own individual circumstances, their individual set of drugs, the premium for the plan that they’re currently enrolled in and how that is changing, rather than assume your experience is going to be the same as what the average beneficiary nationwide will experience.”

It’s important to find out whether the drugs you’re taking will still be on your Medicare drug plan’s formulary, which is a list of covered prescription drugs.

To find out, go to medicare.gov and then to “Plan Finder.” Then type in the list of drugs that you take to see whether the plan you’re enrolled in will continue to cover them in 2015.

You should also consider the quality of a health or drug plan’s customer service. To help you find the best and worst, the Plan Finder provides star ratings for each plan.

“A gold star will show plans with the highest, five-star rating, while a warning icon will alert you to plans that have performed poorly for at least the past three years,” Moos said.

So it’s worth the time for those on Medicare to look at their current health and drug plan now.

“Their health may have changed in the last 12 months, their drugs may have changed in the last 12 months,” Moos said. “What may have seemed like the best choice a year ago may not be the best choice this year.”