MY MEDICARE & YOU came in today’s mail. (Unfortunately the letter carrier failed to deliver a really important piece of mail; sadly that is normal on this route.)1
MEDICARE & YOU alphabetically lists all the services basic Medicare provides.
Medicare Advantage plans (Medicare C) usually provide a great deal more.
It will be October before Medicare-approved Advantage (and Supplemental) plans will be available for review.
Go to www.medicare.gov for a list of all plans available in your area.
IN THE MEANTIME people eligible for Medicare can gather information they will need to compare plans.
When the plans become available in October, prospective plan members will need three documents:
- * Evidence of Coverage (EOC)
* Providers’ List
* Formulary.
They all will be available on line and on request from the companies offering coverage.
Do you like your doctors? If you have a primary care doctor you like, write down his or her name.
Under the primary care’s name write down the names of any specialists you use. Are you committed to those specialists?
- Most Advantage plans are “capitated.” That means that while a plan’s Providers’ List may include 500 specialists, your primary care may only be able to refer you to 50 (10%) of the specialists on the list. You may have to make a choice: change primary care doctor or be willing to see a different specialist.
Most plans allow members to see optometrists and podiatrists on the Providers’ List sans referral
- Check with your primary care physician to determine which, if any, Medicare plans are accepted. Also ask the doctor how responsive the plan is to requests for referrals to specialists.
There ARE alternatives.
Rather than an Advantage plan HMO you could opt for an Advantage plan PPO. The PPO will let you see any specialist in the plan’s network, but at a price. For example, one company offers an HMO plan for no additional (above the monthly Part B Medicare payment) and a PPO plan for an additional $80/month. There also is a Medicare Supplement plan that is an extra cost option.
- An aside. Supplement plans tout that they are portable; plan members can see any doctor and check into any hospital that accepts Medicare. Advantage plans also cover members who travel, but there may be paperwork penalties.
- I tend to check the insurance plans accepted by my preferred hospital and then check to see if my preferred primary care physician (canddate) also accepts any or all of the plans accepted by the hospital.
Pharmacies and pills Make a list of the prescription medications you take. Include name and pill potency, e.g., Metformin 500 mg.
Later, when the Formularies are released, confirm that the drug is listed, and note into what tier the plan has placed the drug. The tier determines any copays, but to find out what the copays are for the tiers, typically four, you must refer to the Evidence of Coverage.
If you have a favorite pharmacy, include its name and address.
When the Providers’ List is available, check to see it the pharmacy is listed.
Subject to change Both the Providers’ List and the Formulary are “subject to change” between January 1 and December 31. The content of the Evidence of Coverage is fixed for the year and cannot be changed.
A word about referrals Many people complain that getting a referral is a pain in the posterior. Referrals are how your primary care physician knows who you are seeing and knows that the specialist “owes” him a report. The primary care is a “clearing house” for all your medical needs and makes certain that one specialist does not contradict the primary or another specialist’s orders. (Another person to trust is your pharmacist who can warn you of any contra-indicated medicines.) I always insist that specialists send reports to my primary care physician and I follow up with my primary to make certain the reports reached the practice.
1. I subscribe to the USPS.com Informed Delivery service. This free and very good service sends me a daily email with scanned images of the letters I can expect in my mailbox. The service includes a feedback for missing mail. I all too frequently am forced to use it.
PLAGIARISM is the act of appropriating the literary composition of another, or parts or passages of his writings, or the ideas or language of the same, and passing them off as the product of one’s own mind.
Truth is an absolute defense to defamation. Defamation is a false statement of fact. If the statement was accurate, then by definition it wasn’t defamatory.
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