November 27, 2022
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Nebraska seniors can review Medicare coverage during open enrollment

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Rules for companies representing Medicare plans

Older Americans now can join, switch or drop a Medicare plan or change Medicare Part D drug coverage or Medicare Advantage plans for the coming year.

Because plans change each year, people should review what they have during this period, said Mike Carsey, a volunteer and board president for Volunteers Assisting Seniors. 

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Beneficiaries’ medications may have changed, he said. And even if they haven’t, the contracts covering those medications may have changed. “There may be savings on the table they can take advantage of if they shop around,” said Carsey, whose organization serves as the east-central Nebraska office of the federally funded Nebraska State Health Insurance Assistance Program covering Douglas, Sarpy, Cass, Washington and Dodge Counties.

If beneficiaries like what they have, they can keep those plans. If they don’t make a change, their current plan will roll over automatically next year.

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Medicare Advantage participants need to check to see whether their provider will still be under their plan next year, Carsey said.  

Volunteers Assisting Seniors, like other such offices across the state, is staffed by trained and certified volunteers who provide free, unbiased consultations with Medicare-eligible clients who are looking for help comparing plans. Open enrollment started Saturday and runs through Dec. 7.

“All we do is help people navigate the murky waters of Medicare,” Carsey said. The Omaha-based office works with between 1,000 to 1,200 people a year. The volunteers help beneficiaries net about $1 million in savings a year. 

For the next year, the highest deductible for a Medicare Part D prescription drug plan will be $505, up from $480 this year, he said. While that’s the maximum set by the government, many plans will have lower deductibles based on the mix of medications a beneficiary uses and the pharmacy they select.

Beneficiaries don’t want to pick a plan based on premium alone, Carsey said. The volunteers will use the plan finder to help them identify the least expensive option from a total cost standpoint, including premiums and medications. 

In another change for next year, the federal Inflation Reduction Act will limit the copay for a one-month supply of insulin to $35. Plans aren’t required to cover all FDA-approved insulins, but they are required to cover one pen form and one vial form of insulin in all four classifications at that rate. Some plans also will offer insulin at lower costs. 

Also under the act, Medicare will begin negotiating the prices of certain high-cost drugs, Carsey said. That change won’t start until 2026, and negotiations will be limited to 10 high-cost drugs that have yet to be identified.

Beginning in 2025, the act also implements a $2,000 out-of-pocket cap on drugs under Part D. Carsey said some people have inferred that that means the drug coverage gap, also known as the doughnut hole, will go away. Whether that will happen, however, has yet to be decided.

Carsey said the organization conducts most consultations over the phone. To make an appointment, call 402-444-6617. To contact other such groups around the state, call 800-234-7119.

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