Of the more than 45 million people relying on Medicare for health care coverage, many may be paying for a plan that doesn’t meet their needs or is too expensive. However, Medicare annual enrollment, which starts Nov. 15 and ends Dec. 31, offers anyone with Medicare the opportunity to switch plans so that they’re getting the most from their coverage.
“Many people don’t understand they have a wide variety of choices when it comes to Medicare coverage and too few review their needs before re-enrolling each year,” says Paul Gada, personal financial planning director for Allsup Medicare Advisor, an objective plan selection service that helps people understand and choose the most appropriate Medicare plan for their health care needs.
Individuals need to consider the following questions to evaluate whether they should switch plans before the enrollment deadline:
1. Will traditional Medicare or Medicare Advantage work best for me?
If you visit the doctor often and take prescription drugs, a Medicare Advantage plan may best fit your needs. If you only require routine medical visits and few prescriptions, traditional Medicare with a prescription drug plan may work best. From year to year, your answer to this question may change since your needs are likely to change.
2. Do I need a supplemental plan?
Medicare supplemental insurance can help pay costs not covered under traditional Medicare. However, not everyone needs this coverage, including those who are eligible for Medicaid, have employer-provided group health insurance or have a Medicare Advantage plan.
3. Should I use Medicare instead of my private health coverage?
If you have coverage through a former or current employer, speak to the plan administrator before making changes. Consider comparing your private plan to your Medicare options, especially if your private plan is limited or the cost has increased significantly.
4. Can I keep my doctors?
The majority of health care providers (doctors, hospitals, physical therapists, etc.) accept traditional Medicare. Medicare Advantage plans offer broad access, but this doesn’t mean all doctors participate. Before joining a plan, determine if your doctor accepts it.
5. Does the plan cover prescription drugs?
Traditional Medicare doesn’t generally cover medications unless they’re administered in the doctor’s office or hospital. You have to enroll, usually at an additional cost, in a Part D plan for this coverage. Medicare Advantage plans, however, can offer prescription drug coverage.
6. Are my drugs covered?
Each prescription drug plan has a list of drugs (formulary) that it covers. Drugs covered by a plan can change, so you need to review this list each year.
7. Are my prescriptions expensive enough that I could fall into the Medicare “donut hole?”
Medicare Advantage plans with prescription drug coverage and stand-alone Part D plans may have a coverage gap, sometimes known as the “donut hole.” This means once you have paid your deductibles and the plan has paid its coverage — you’ll have to pay the full cost until it reaches a certain dollar level. In 2009, this dollar amount was $3,453.75. Only after this out-of-pocket amount is paid does Medicare begin covering costs again.
8. How much will I have to pay?
Traditional Medicare may be inexpensive, but it comes with high deductibles. Medicare Advantage plans may have similar or higher monthly premiums, but offer a zero-dollar deductible and low co-pays; some also cap total out-of-pocket costs.
9. Will the plan cover additional
Some Medicare Advantage plans cover dental, vision and health and wellness programs not available through traditional Medicare.
10. Will I be covered while traveling?
Traditional Medicare provides coverage nationwide. Some Medicare Advantage plans restrict coverage to certain areas, but many offer out-of-network coverage for emergency care.
Reviewing your needs every year — especially with the experienced help of an independent Medicare plan selection service like Allsup Medicare Advisor — before annual enrollment is crucial to ensure coverage, Gada says.
“Medicare is like any other type of insurance; you don’t want to be under-insured. But you also don’t want to pay for things you don’t need,” Gada says.
For more information, Allsup offers a free screening to help determine eligibility for Allsup Medicare Advisor at ama.allsup.com.
Courtesy of ARAcontent