The open enrollment period began Oct. 15.
The first of 54 days that Americans 65 and older have to make their Medicare choices for 2020. These choices could save you hundreds, perhaps thousands of dollars a year and could well determine the quality of your health care, as well as your health, for years to come.
Don’t let a lack of knowledge be the reason that you do not choose the best Medicare plan for you. Consider these six things when making your Medicare selection this year.
Choose between original or advantage.
How much are your premiums, deductibles and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs, as well as what the differences in costs between original and advantage plans.
Original Medicare: There’s no limit on how much you pay out-of-pocket per year unless you have supplemental coverage.
Medicare Advantage: Plans have a yearly limit on your out-of-pocket costs. If you join a Medicare Advantage Plan, once you reach a certain limit, you’ll pay nothing for covered services for the rest of the year. This option may be more cost effective for you.
Which coverage right for you?
Medicare covers medical services and supplies in hospitals, doctors’ offices and other health care settings. Services are either covered under Part A or Part B. Advantage plans must cover all of the services that Original Medicare covers, in addition to other benefits like vision, hearing or dental.
Part A: Generally covers inpatient care in a hospital, care within a skilled nursing facility, inpatient care in a skilled nursing home (not long-term care), hospice care and home healthcare.
Part B: Generally covers medically necessary services (services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice). Part B also covers preventative services, such as healthcare that works to prevent illnesses (like the flu) or to detect an illness at an early stage, when treatment is available and will likely work.
Part B also covers things like clinical research, ambulance services, durable medical equipment, mental health, inpatient and outpatient services, partial hospitalizations, surgery second opinions and limited outpatient prescription drugs.
Consider gap Medicare coverage (if you’re using an original Medicare plan).
If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare.
Supplemental coverage in Original Medicare: You can add a Medigap policy to help pay your out-of-pocket costs in Original Medicare, like your deductible and coinsurance.
Supplemental coverage in Medicare Advantage: It may be more cost effective for you to join a Medicare Advantage Plan because your cost sharing is lower or included. Many Medicare Advantage plans also offer vision, hearing and dental benefits. You can’t use a Medigap policy if you’re in a Medicare Advantage Plan.
Will you need to switch doctors?
Doctors are special people in our lives. We build trusting relationships with them. Having to select a different doctor due to choosing the wrong Medicare plan would be a true nightmare. But what if the doctors in your Medicare plan that you’d like to see aren’t accepting new patients? Do you need to get referrals to see these doctors?
Original Medicare: You can go to any doctor that accepts Medicare.
Medicare Advantage: You may need to use health care providers who participate in your plan’s network. If so, find out how close the network’s doctor or pharmacies are to your home. Some plans offer out-of-network coverage, but not all.
Do you travel frequently?
Having medical coverage can ease one’s mind when traveling abroad. Don’t let Medicare determine be the reason you cannot travel as your desire.
Original Medicare: Generally doesn’t cover care outside the U.S. You may be able to buy supplemental insurance that offers travel coverage.
Medicare Advantage: Plans usually don’t cover care you get outside of the U.S.
Which is best for your prescription drug needs?
Do you need to join a Medicare Prescription Drug Plan? Do you already have creditable prescription drug coverage? Will you pay a penalty if you join a drug plan later? What's the plan’s overall star rating? What will your prescription drugs cost under each plan? Are your drugs covered under the plan's formulary? Are there any coverage rules that apply to your prescriptions? Are you eligible for a free Medication Therapy Management (MTM) program?
Original Medicare: You’ll need to join a Medicare Prescription Drug Plan (Part D) to get drug coverage.
Medicare Advantage: Most Medicare Advantage Plans include drug coverage. If yours doesn't, you may be able to join a separate Part D plan.
There as so many questions that come with enrolling in Medicare. Don’t let yourself go uneducated. The Medicine Shoppe, located at 400 Jefferson Ave in Washington, Pa, is staffed with Medicare experts who are ready and willing to walk your through all of the options available during this enrollment period. You can also reach them Monday through Saturday at 724-222-0900.
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