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Medicare: Know Your Options

Medicare’s annual open enrollment period is October 15th through December 7th. During this window, seniors can change their existing Medicare plans and prescription drug coverage to better meet their needs for the upcoming year. It’s important for seniors to review their plans for any changes in cost, coverage, and what providers and pharmacies are in their networks. Choosing the best plan begins with understanding what is offered and finding a balance between out-of-pocket costs and an affordable monthly payment. To begin, one needs to understand the basics of Medicare and how all the parts work. (sources: Medicare.gov, cms.gov)

Part A (Original Medicare) – Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Most people don’t pay a monthly premium.

Part B (Original Medicare) – Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Monthly premiums vary depending on income.

Part C (Medicare Advantage Plans) – Part C includes what parts A and B cover, and often prescription drugs, dental and vision. Medicare Advantage plans are offered by private insurance companies that contract with Medicare to provide all the Part A and Part B benefits. These plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. There is usually a monthly premium.

Part D (Prescription Drug Coverage) – Part D adds prescription drug coverage to Original Medicare plans. These plans are also offered by insurance companies and other private companies that contract with Medicare, and there is a monthly premium.

Seniors can reference their red, white and blue Medicare cards to see what type of coverage they have. For additional help, they can call 1-800-MEDICARE.

During this time of the year, seniors may be bombarded with mailings from different plans. Patricia Barry, author of “Medicare for Dummies” and features editor of AARP Media, said it is best to disregard most of these because they are primarily promoting their own plans. “Only by comparing them can you find out which is the best one for you,” she said. However, Barry said there is one piece of post that seniors should definitely hold on to – the Annual Notice of Change letter they should receive from their current Medicare plan provider by late September. This will notify the senior of any changes being made to their current plans for the upcoming year.

“By law, the plan has to say how it will change in the coming year, if it does at all,” Barry said. “Most people toss this; they don’t read it. They should. What they should do is compare their own plan with what is being offered by other plans in their own area for 2016.”

If a senior’s plan is changing, they should make sure the plan will still meet their needs for the upcoming year. There are many things to take into consideration when deciding on any changes to a health care plan – how much the insurance is used, how often a senior visits the doctor, if prescription drugs are used regularly, if the senior is fairly healthy, etc. If the senior is still confident that the current plans will still meet her needs, she doesn’t need to do anything. Any changes made go into effect on January 1st of the new year.

Seniors should be wary of changes in their plans, because they happen every year, according to Barry. “The real reason for comparing plans is to avoid really nasty surprises in January if you stay on the plan you’ve got. It won’t always happen, but it does,” she said. “Every January I get emails from people who are outraged, saying, ‘My co-pay for my drugs went up three times. Why?’ Well, the reason is that they didn’t find out what the plan was going to charge them for those drugs each year.”

When it comes to making changes to Medicare plans, not only should seniors know what to ask, they should also know who to ask. Health economist Gail Wilensky said there have been major changes in the way Medicare distributes information and in how seniors receive it. Many resources are now available online. “There’s a lot of information that’s available, but it depends on how comfortable seniors are navigating around the websites,” Wilensky said.

If a senior needs help navigating their Medicare plan options, there are several resources available, online and off. Medicare.gov offers a digital calculator that allows seniors to input their particular insurance and prescription drug needs, and to compare plans in a confidential and anonymous environment. The website also offers free downloads of informational packets on all things Medicare. Family and friends with experience can also be a great resource for seniors making decisions. Knowing and comparing all the options will help seniors make the best choice for their healthcare needs.

 

Written by Taylor French, Amada contributor. 

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