Shop and find the best deal: Compare plans to find the best deal, not only in monthly premiums, but also in the overall estimated annual cost of deductibles, cost sharing, etc. Make sure your provider accepts Medicare or your Medicare Advantage Plan. Shop pharmacies to find the least expensive prescription drug costs.
Apply for programs that help you save: Check to see if you qualify for Medicare Savings Programs, Part D Extra Help (LIS), Healthy Horizons (Medicaid), or a Pharmacy Assistance Program. The income and asset limits are different for each program. If you are close to the limit, go ahead and apply. Sometimes the program will disregard some of your income or resources. If you’re unsure, check with an APPRISE Counselor.
Use covered benefits: Make sure you understand which prescription drugs, lab tests and medical services will be covered by Medicare and your insurance plan. Hospital, home health care, skilled nursing and some types of therapy require that you meet strict guidelines before you are covered. Also, keep up on how many visits you have used throughout the year. A limited number of visits are allowed for some types of therapy.
Review your bills carefully: If you have Original Medicare, make sure that the bills your doctor sends you, the Explanation of Benefits (EOB) your plan sends you, and your Medicare Summary Notices (MSN) are correct. Check to see that you received the services you were billed and that everything was reimbursed according to your plan’s benefits booklet.
Appeal all claims that are denied: Any time Medicare or your plan will not cover a service you think they should, submit an appeal. Claim denials are often overturned, and the plan usually ends paying their share. If your prescription drug is not on your plan’s formulary, or it is not provided in the quantities you need, submit a coverage determination. The plan must cover the drug if your doctor says it is required, at least until the end of the year when you will need to choose a new plan.
Take good care of yourself: There’s nothing better for your pocketbook than not getting sick in the first place. Take advantage of all the covered preventive care Medicare has to offer. Also, pay attention to the early signs of illness. It’s always better to get treated before an illness develops into something more serious. Finally, take steps to maintain healthy habits. They will pay off in better health and cheaper medical costs down the road.
APPRISE is a free, public program of the Pennsylvania Department of Aging that gives advice. APPRISE does not sell or endorse any insurance plans or products. For information, call 1-888-300-2704, ext. 4438.