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To get out of Medicare HMO, act by Tuesday. But it’s tricky

Medicare patients who enrolled in an HMO for 2012 and now have buyer’s remorse can still drop out of their plan  if they act by Tuesday. But they could wind up a lot worse off if they’re not careful, experts say.

February 14 marks the end of the disenrollment period for Medicare Advantage (MA) -- the private managed-care substitute for the government insurance program for the elderly and disabled.

Unhappy MA members have the option of “disenrolling” and going back to original Medicare. They can also sign up for a Medicare-subsidized prescription drug plan.

Those who are already in traditional Medicare with a prescription drug plan cannot make any changes.

It can be very confusing, especially for beneficiaries who weren’t in managed care during their working years.  Instead of having stable coverage, as in traditional Medicare, the benefits and prices in MA and prescription drug plans change year to year.

It’s especially confusing this year, because for the first time those enrolled in MA plans can’t switch to another MA plan in the early months of the year. Their only option is traditional Medicare with a drug plan.

Here’s where Medicare beneficiaries  need to watch out, because those enrolled in original Medicare have to pay 20 percent of their bills unless they can afford a supplement plan, often called Medigap.

Not only that, signing up for a prescription drug plan can be tricky for those who are accustomed to getting drugs through their HMO.

No prescription drug plan covers every drug on the market and the difference in coverage can be substantial, says  Ross Blair, CEO of PlanPrescriber.com, a private company that helps beneficiaries compare drug benefits. (Medicare offers a plan-finder, as well, at this site.)

In Florida, Blair said, there is a big difference between two of the top-10 drug plans in enrollment. Part of the difference lies in cost – premiums as well as co-pays – while part lies in the extent of coverage.

Blair gives this Florida-specific example:

WellCare Classic costs $27 a month, while Humana Enhanced costs $41.50 a month. But WellCare has a $320 deductible, while Humana Enhanced requires none.

Also, Humana Enhanced’s formulary – list of covered drugs – includes 79 percent of all drugs on the market. Meanwhile, WellCare Classic covers only 47.5 percent.

“That’s why it’s really important for Medicare patients to make sure the drugs they take are covered by the plan” before they sign up, Blair said.

Some Medicare patients say they were misled on the government's plan-finder, according to an article in The Hill,  because it says drugs are free on some plans without making clear that it's only true for certain pharmacies.

Even if the co-pay is just $5 to $7, that's significant to retirees. The median income for those 65 and older is about $25,500 for men and about $14,600 for women, Blair noted.

"What is critical for seniors is to understand why their costs may be higher than they expected and make sure they’re fixing the right problem," Blair said.

Each state has a federally-funded volunteer program to help seniors and the disabled figure out their best options. In Florida, that program is called SHINE, for Serving Health Insurance Needs of Elders. It's operated by the state Department of Elder Affairs.

To get help from a SHINE volunteer, call 1-800-96-ELDER (1-800-963-5337) or email information@elderaffairs.org.

--Health News Florida is an independent online publication dedicated to public-service journalism. Editor Carol Gentry can be reached at 727-410-3266 or by e-mail.