Got Medicare sign-up headache? Here's help

In a simpler time, Americans turned 65, got on Medicare and that was that.

Then came private Medicare fee-for-service plans, private Medicare managed-care plans and Medicare Part D plans for prescription-drug coverage — all sold by dozens of companies offering a dizzying array of choices.

Then more and more doctors stopped accepting the old, "traditional" Medicare and even certain kinds of private Medicare plans.

So now it's time for the "annual nightmare period," as many have come to know it — the open-enrollment window that sends far too many confused seniors rummaging for their benefits booklets.

Starting this week and until Dec. 31, seniors on Medicare can switch their medical coverage, whether they have traditional Medicare or private Medicare Advantage plans. They also can sign up for new Medicare drug coverage or switch from an existing plan.

Switching isn't required. But experts advise seniors that it's smart to review their coverage each year to make sure they're on the best plan for their needs.

And the experts also say it doesn't have to be a nightmare. Here are some of their tips:

Q: I'm happy with my current coverage. So why bother with open enrollment?

A: Premiums for your plan might have gone up, or benefits may have changed. At the same time, new private Medicare Advantage plans roll out every year, including 28 new ones in King County in 2007.

Also, your health may have changed, or you may be taking new prescription drugs. Or you may simply want to switch doctors or hospitals.

Q: I have traditional Medicare. Will my doctor continue to accept it?

A: Under traditional Medicare, most of your medical claims are paid by the federal government. But some doctors are turning away traditional Medicare patients because of low reimbursement rates and because they say they can't coordinate a patient's overall medical care as well.

For example, The Edmonds Family Medicine Clinic says it will no longer accept traditional Medicare or Medicare supplement plans beginning in January. The Everett Clinic, on the other hand, has decided to drop a different type of plan, the private fee-for-service Medicare Advantage plans, including those sold by Humana, Advantra Freedom and Coventry, after December 2008.

Q: I saw an ad for a Medicare Advantage plan with free monthly premiums. What's the catch?

A: It's not quite "free," because the government will still be deducting your Medicare Part B premiums for physician services (slated to rise to $96.40 a month starting next year) from your Social Security checks. The premiums for private Medicare plans pay for extra benefits you don't get with traditional Medicare.

Pay close attention to caps placed on annual out-of-pocket maximums, warns Dave Lilly, a longtime volunteer with the state's health-insurance consumer advisory group. Some zero- or low-premium plans do not have any limits on how much you'd have to pay out-of-pocket in case of a serious medical problem.

Then again, if you are somehow sure you're not going to get sick, or have the financial means to cope if you do, then go for the zero-premium plan, Lilly says. "Why pay for something you don't need?"

Q: Would it be better to buy a stand-alone Part D prescription-drug plan?

A: Some private Medicare Advantage plans include prescription coverage. You should review your medications and do the math to figure out whether an all-inclusive plan is best for you.

Many seniors sign up for a stand-alone Part D plan when they already have prescription coverage through their Medicare medical plans, says Paddy Cottrell, president of The Benefits Co., an insurance agency in Lynnwood. That will cancel your existing prescription coverage — and create a lot of headaches.

Kyung Song: 206-464-2423 or ksong@seattletimes.com