Medicare open enrollment time is fast approaching, it starts on October 15th and goes through December 7th. This year especially, we should make sure we are prepared to make smart decisions concerning our healthcare. It can make a difference in our access to the care and how much we pay for that care.
First, some background – we really have two choices in selecting our healthcare – standard Medicare and Medicare Advantage (MA). Standard Medicare is based on the old fee for service model. People often add supplemental insurance to standard Medicare to reduce or eliminate out-of-pocket costs. The MA model is based on the insurance company getting one fee for each Medicare enrollee, which encourages the insurance company to emphasize preventative care and offer programs to keep us healthy. With MA there are often no premiums and there are often more benefits, such as prescription drug coverage, dental, hearing and health clubs, etc. The tradeoff is higher out-of-pocket (OOP) costs for many services and some limits on choices of doctors. If your situation enables you to take advantage of the added benefits that MA offers and the doctors you use are part of the MA network, then MA may be a good choice for you. I changed from standard Medicare to Medicare Advantage last year and found that I saved money, even with a battery of tests I had done.
Part D, the prescription drug program, is another place where careful consideration can be very beneficial. Part D is often included in a MA plan but you should pay special attention to your choice of your Part D provider no matter which Medicare plan you choose.
While I can’t tell you which type of Medicare you should choose, I can give you some things to consider as you get ready for open enrollment. They are, in no particular order:
- While historically less than 10% of us change our Medicare plans, statistics show that the average person can save $300 or more when they review their coverage.
- Your options for Medicare plans have increased 20%. You will have an average of 47 different health plans to choose from.
- There are two main areas to consider when you are evaluating different plans, can I get easy access to the care and products I need and what will my OOP costs be? For Part D, for instance, you first need to make sure the plan you are considering offers the medicine you take and then determine what it will cost.
- Evaluate how your current plan did, were you happy?
- Your insurance companies are required to send you an explanation of any coverage changes that will affect your plan. These changes can have a big impact on next year’s access and cost. They may have dropped your doctor or the medicine you take, they may have increased OOP costs.
- Research if you qualify for Medicare assistance under the Social Security Disability Insurance (SSDI) benefit or the Patient Assistance Program.
- Pay attention to the Medicare Star ratings on Part D and MA plans.
- If you plan on traveling next year, especially if it’s out of the U.S., review what your plan will cover when you are traveling.
- Research what your maximum yearly OOP maximums will be. For MA plans the maximum OOP costs for 2020 was $6,700, some plans are less.
- It is often to your benefit to get a separate Part D plan than your spouse. Your medicines may be available and cost less under a different plan than your spouse’s.
- There are situations when you can change or apply for Medicare outside of the open enrollment period:
- Loss of health coverage: The loss of a job or qualification for Medicare or Medicaid services, or aging out of your parents’ plan.
- Changes in household: A birth, adoption, death, marriage, or divorce in the family.
- Changes in residence: Moving to a new region outside of your current insurer’s coverage.
- Other qualifying events: Becoming a U.S. citizen, leaving incarceration, joining or leaving the AmeriCorps.
These are a few things to consider as you evaluate your coverage. You do have places you can go to get help with choosing your coverage. Here are four great places to get help:
1.Contact your local SHIP office.
The State Health Insurance Assistance Programs (SHIPs) give free, in depth, one-on-one insurance counseling and help. A SHIP counselor, who understands Medicare and Medicaid can guide you to smart options for your personal situation. You can trust them because SHIPs are government programs funded by the federal U.S. Department of Health and Human Services. Find your state’s SHIP office .Contact your local Area Agency on Aging. The local Area Agency on Aging has programs that help with Medicare Open Enrollment. Find your local Area Agency on Aging
2.Use Medicare’s online plan finder.
Medicare has an online plan finder and comparison tool. Answer a few quick questions and the tool will show available plan options for 2021.
4.Call 1-800-MEDICARE (1-800-633-4227).
You could also call the Medicare office and ask a representative to run a search for plan options and mail you the results. This takes extra time, so call ASAP if you want to use this method.
I hope this helps you as you consider your healthcare options during this open enrollment period.
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Stay healthy, Thair