2016 Medicare Enrollment Period is Here and 2016 Prices Are Rising

2016 Medicare Enrollment Period is Here and 2016 Prices Are Rising

The annual Medicare open enrollment period opened October 15th and closes December 7th.  Lita Epstein is the author of “The Complete Idiot’s Guide to Social Security and Medicare” and believes everyone should consider switching every year as plans changes, benefits change and premiums change.


But this year comparing plans is critical as experts in the field say that in 2016 premiums, on average, will increase 13% and there will be a vast range of plan costs depending on the plan and on the state where the person lives.  They believe many Medicare recipients could save money and improve their health coverage by choosing new plans.  According to the Avalere Health consultancy, more than 15 million people enrolled in the top 10 Medicare Part D” prescription drug plans will face average premium hikes of 8 % in 2016.  Those top 10 plans account for more than 80% of enrollment in such drug plans.  They say five of the top prescription drug plans will see double-digit premium hikes next year.


It’s a very complex subject.  Below is an overview of the Medicare plans and its components, questions you should ask.  Once you answer the questions, you need to identify the plans best for your needs and spend time comparing the plans.


Medicare Plans and Components:


  • Part Acovers hospital care, skilled nursing, hospice and some home health care. If the individual or their spouse has at least 10 years of Social Security work history, this part is free. If not, it can be up to $407 per month. The premium amount is determined by how many Social Security work credits a person has.
  • Part Bcovers doctor visits, preventive care, outpatient care and hospitals and some home health care. In 2015, this part cost $104.90 a month for Medicare beneficiaries whose incomes are $85,000 a year or less ($170,000 for a couple) and up to $335.70 for those whose annual income exceeds $214,000.
  • Part C is also known as a Medicare Advantage plan. It substitutes for parts A and B and, in most cases, Part D, the drug plan. Premiums range from $0 to more than $100 a month, varying by location and coverage. According to the Centers for Medicare & Medicaid Services, the average premium in 2016 will be $32.60.  Although plan dependent, Floridians will likely see increases in 2016 beyond the $32.60.
  • Part Dcovers prescription drugs. Premiums are about $15 to $50 per month.

The first big decision Medicare beneficiaries must make is whether to go with traditional Medicare (parts A, B and D) or a Medicare Advantage plan (Part C). Medicare Advantage plans have lower premiums, but they usually require members to get their care only from network doctors and hospitals. Both options have deductibles, copays and co-insurance, where the individual/spouse pays a percentage of the bill.


According to the U. S. government, the most pressing questions that need to be addressed are:


  1. Coverage:How well does the plan cover the services you need?
  2. Your other coverage:If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare.
  3. Costs:How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.
  4. Doctor and hospital choice:Do your doctors accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and health care providers from a network? Do you need to get referrals?
  5. Prescription drugs:Do you need to join a Medicare Prescription Drug Plan? Do you already have creditable prescription drug coverage? Will you pay a penalty if you join a drug plan later? What’s the plan’s overall star rating? What will your prescription drugs cost under each plan? Are your drugs covered under the plan’s formulary? Are there any coverage rules that apply to your prescriptions?
  6. Quality of care:Are you satisfied with your medical care? The quality of care and services offered by plans and other health care providers can vary. How have Medicare and other people with Medicare rated your health and drug plan’s care and services?
  7. Convenience:Where are the doctor’s offices? What are their hours? Which pharmacies can you use? Can you get your prescriptions by mail? Do the doctors use electronic health records (EHRs) or E-prescribe? Can you get an electronic copy of your information by email or to store in a personal health record? Which pharmacies can you use? Is the pharmacy you use in the plan’s network? If it’s in the network and your plan offers preferred cost sharing, does your pharmacy offer preferred cost sharing? You may pay less for some drugs at pharmacies that offer preferred cost sharing. Can you get your prescriptions by mail?
  8. Travel:Will the plan cover you if you travel to another state or outside the U.S.?


If you need help evaluating plans, the Resource Directory on our website provides professionals who can help.  Go to http://theseniorsanswer.com/resources/.


If you have questions or need information about your loved-one’s life issues don’t hesitate to reach out to us.  We love helping our clients get the information they need from personal issues to daily money management, home management and more.