By Rick Banas of Gardant Management Solutions
For those of us on Medicare, this is a very important time of year.
The Medicare Open Enrollment Period began on Oct. 15 and continues through Dec. 7. During the Open Enrollment Period, you can look at and compare the health and drug plans that will be available next year and pick the plan or plans that best meet your needs.
As Melissa Versch, Senior and Family Services Clinical Supervisor with the North Shore Senior Center, explained during a Medicare Open Enrollment webinar hosted by U.S. Rep. Brad Schneider, there are a number of reasons why you should compare plans on an annual basis.
The reasons cited by Versch included the following:
The health and drug plans you currently have may not be offered next year.
There may be changes to coverages and costs; to the benefits that are included; to the covered network of doctors, hospitals, and other health care providers; to the list of drugs that are covered; and to the list of preferred pharmacies.
There may be changes to the ratings that plans receive.
Your needs may have changed.
You may be able to save money by finding health and drug plans that better meet your needs at a lower cost.
You can check to see if Original (also known as Traditional) Medicare or a Medicare Advantage Plan might better fit your needs.
With Original Medicare, Part A helps cover inpatient care in hospitals, hospice care, and a limited number of days in a skilled nursing center for rehabilitation after a qualifying inpatient hospital stay.
Part B helps cover medically necessary services from doctors and other health providers, outpatient tests and services, durable medical equipment such as wheelchairs and walkers, and many preventive services.
Medicare Part A and Part B also can cover home health services as long as you need part-time or intermittent skilled nursing, physical therapy, occupational therapy and/or speech therapy and are homebound.
Part D coverage helps cover the cost of prescription drugs.
One of the new benefits that is highlighted in the 2022 Medicare & You official Medicare handbook is cognitive assessment and care plan services. According to the manual, when you see your provider for a visit, they may perform a cognitive assessment to look for signs of dementia, including Alzheimer’s disease. Because conditions such as depression, anxiety and delirium can also cause confusion, it is important to understand why you may be having symptoms. If there are signs of cognitive impairment, Medicare also will cover a separate visit with your regular doctor or specialist to do a full review of your cognitive function, establish or confirm a diagnosis of dementia, and develop a plan of care.
Versch noted that Original Medicare was never meant to cover all health care costs. With Original Medicare, there are premiums, deductibles, and out-of-pocket costs. For instance, after you meet your deductible under Part B and Medicare begins to pay its share, you typically are obligated to pay 20% of the Medicare-approved amount for the service if the doctor or health care provider accepts Medicare. There is no yearly limit on what you have to pay out-of-pocket.
Purchasing Medicare Supplement Insurance (also known as Medigap) can help you pay for expenses not covered by Original Medicare. In addition, some plans offer coverage for services that Original Medicare does not cover. Medicare Supplemental Insurance policies are sold by private companies. The plans must follow federal and state laws designed to protect you.
The alternative to Original Medicare is a Medicare Advantage Plan (also known as Part C). The plans are sold by private companies. The plans bundle Part A, Part B and usually Part D coverages, they must be approved by Medicare, and they must provide coverage that is at least as good as Original Medicare.
When looking at Original Medicare versus a Medicare Advantage Plan, here are a few things to keep in mind.
With Original Medicare, you have the flexibility to go to any doctor or hospital anywhere in the United States that accepts Medicare. In most cases, you do not need a referral to see a specialist.
A Medicare Advantage Plan may include some extra benefits such as dental, vision, hearing services; over-the-counter drugs; home repairs; fitness programs; and transportation. Your out-of-pocket costs may be lower. On the flip side, in most cases, you will need to use doctors and other health care providers that are in the plan’s network, and you may need prior approval to see a specialist.
It all depends on what your needs are, Versch said. You can keep your current plan(s), switch from Original Medicare to a Medicare Advantage Plan, switch Medicare Advantages Plans, or switch from a Medicare Advantage Plan to Original Medicare. Any change you make will become effective as of Jan. 1, 2022.
You can also call 1-800-MEDICARE (1-800-633-4227)
Assistance is available at no charge from specially trained State Health Insurance Program counselors. The SHIP counselors are not affiliated with any insurance company. To find a SHIP near you, go to https://www.shiphelp.org/