Your health plan is one of the biggest decisions you’ll make this year. People that research their decision are far more likely to make a good choice. If you’re Medicare-eligible, here’s what you need to know for the Medicare enrollment season, running Oct. 15 through Dec. 7.
Start by knowing the basics. Even if you’re already using Medicare, you need to understand the main components: Original Medicare (Medicare Parts A and B), Medicare Advantage Plans (Medicare Part C) and Prescription Drug Plans (Medicare Part D). In a nutshell, Original Medicare includes hospital insurance and medical insurance and you may choose to add a Medicare Supplement plan — often called a Medigap plan — along with a stand-alone prescription drug plan. Medicare Supplement plans cover all or some of the medical charges not covered by Original Medicare, including the 20 percent coinsurance for most services.
Because Original Medicare or Medicare Supplement plans don’t offer prescription drug coverage, it’s necessary to enroll in a stand-alone Prescription Drug Plan (Part D) for coverage.
Medicare Advantage Plans, offered through Medicare-approved private companies, typically include not only hospital and medical coverage, but also prescription drug coverage. Medicare Advantage plans may also include benefits such as dental coverage, fitness memberships and special services for people with diabetes, heart disease or other conditions. Go to Medicare.gov to learn the differences.
Just as you would talk to a mechanic or a knowledgeable friend before buying a car, talk with your doctor about expected health needs in the coming year. Any planned surgeries or medication changes?
Consider your health goals. Are you planning to lose weight? Run your first 5K? Prepare for an active vacation? Then, make a list of what you want in a health plan. Particularly within Medicare Advantage, many plans offer powerful services to help you achieve your best health.
Medicare.gov is the place to start learning about the plans available to you. Learn the costs to buy the plan (premium), costs to use the plan (deductibles and co-payments), and the maximum you might have to pay in case a serious health event happens (maximum out of pocket). Learn about the doctor and hospital networks included in each plan.
Plans can change every year, so even if you already have a Medicare plan, be sure to check. Medicare.gov also offers Star ratings, a five-star system that rates the quality of services provided by each plan.
While Medicare.gov is the best place to start, also visit the Medicare Advantage plan websites to get into specifics about plans you may be interested in. Whether or not your plan is changing, it’s important to know all the details.
Your plan choice this fall is guaranteed and will be yours for all of 2016, unless you qualify for a Special Enrollment Period (SEP) and choose to make a change. With news of possible health plan mergers among Medicare Advantage plans, it’s important to understand that this does not affect your 2016 plan choice.
In the end, if we get in the habit of considering Oct. 15 through Dec. 7 health prep season, just like March and April is tax prep season, we’ll make the right decision for our financial, emotional and physical health. So, while the question may be switch it or stick with it, the key to Medicare success is research it.
Larry Costello is the president of Medicare products for Humana for the Wilmington area.
