By Rick Banas of Gardant Management Solutions
If you are on Medicare, here is a simple step you should take each year to make sure you are getting the most out of Medicare.
During the annual Medicare Open Enrollment Period, take the time to compare your current medical and drug plan coverages with other options that will be available in the new year.
Shari Hanson of ElderCare Services of DeKalb County emphasized the benefit of taking the simple step during her presentation on “Medicare and You” earlier this month at the Heritage Woods of DeKalb affordable assisted living community. Shari is specially trained as a State Health Insurance Assistance Program (SHIP) Medicare Counselor.
There may be changes to your current health and drugs plans that impact what is covered, the costs and the benefits. There may be plans that will better meet your needs. You may be able to save money or get extra benefits.
Options for Medicare Coverage
As Shari explained, Medicare can get confusing. There are two main options for Medicare coverage. One option is Original Medicare (also referred to as Traditional Medicare). The other is Medicare Advantage. There also are Medicare Supplement Insurance (Medigap) plans and Prescription Drug Plans.
If you have limited income and meet certain conditions, you may be able to get help paying for some of your health and prescription drug costs.
If you qualify for Medicaid, you may qualify for additional benefits when you enroll.
Original Medicare has two main parts – Part A (Hospital Insurance) and Part B (Medical Insurance). You also can join a separate Medicare Drug Plan (Part D).
Part A helps cover inpatient care in a hospital, short-term rehabilitation in a skilled nursing care facility, certain home health care services, and short-term hospice care. Co-payments, co-insurance, and deductibles may apply.
Part B helps cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and many preventive services. A deductible amount ($203 in 2021) may apply. After you have met the deductible amount, Medicare begins to pay its share and you typically pay 20% of the Medicare- approved amount for the service so long as the doctor and other health care providers who provide the service accept Medicare.
You are able to go to any hospital, doctor, or other health care provider in the United States that takes Medicare. In most circumstances, you do not need a referral to see a specialist.
With Original Medicare, you can also buy Medicare Supplement (Medigap) Insurance to help you pay for your out-of-pocket expenses that are not covered by Medicare. Unless you have a Medigap policy, there is no cap or limit on out-of-pocket expenses.
Medicare Advantage (known as Part C) is an “all-in-one” alternative to Original Medicare. Part C Plans are similar to HMO or PPO plans. They combine Part A and Part B coverage and usually Part D.
Medicare Advantage Plans may have lower out-of-pocket costs than Original Medicare and most Medicare Advantage Plans offer extra benefits such as some vision, hearing and dental benefits that are not currently covered by Original Medicare.
Medicare Advantage Plans have a yearly limit on what you pay out of your pocket for covered services. At the same time, you will need to use doctors and other health care providers who are in the plan’s service area and provider network. You may also need to get a referral to see a specialist.
Why an Annual Review
Here is why comparing your current Medicare coverage with other options that will be available in the coming year is so highly encouraged.
There may be changes to your current Medicare coverages that will take effect in the new year. There may be changes to the premiums, deductibles, and co-pays. There may be changes to the benefits. There may be changes to the hospitals, doctors and other health care providers that accept Medicare or that are part of your Plan’s network.
Likewise, there may be changes to other Medicare Plans that will take effect in the new year.
Your health care needs may have changed.
You may find that there are plans that will better meet your needs, provide you with additional benefits, and possibly save you money.
The Medicare Open Enrollment Period typically runs from Oct. 15 through Dec. 7. If you are enrolled in Medicare, you can change your Medicare health and drug plans during this period of time. This includes going from Original Medicare to a Medicare Advantage Plan, from a Medicare Advantage Plan to Original Medicare, or from your current Medicare Advantage Plan to a different Medicare Advantage Plan.
If you decide to stay with your current Medicare coverage, there is nothing you need to do. Any changes to your plan’s benefits or cost will take effect on Jan. 1.
If you decide to change your Medicare coverage, the new plans(s) will take effect on Jan. 1.
Please note that Medicare in past years has given those in a Medicare Advantage Plan the opportunity between Jan. 1 and March 31 the opportunity to switch from one Medicare Advantage Plan to another Medicare Advantage Plan or from a Medicare Advantage Plan to Original Medicare. Individuals are limited to one change during this period.
There are several ways you can get help choosing the Medicare coverage that is right for you.
▪ Personalized counseling is available at no charge from specially trained counselors at local SHIPS. The SHIPS are not connected to any insurance company or health plans.
To find a local SHIP near you, click here https://www.seniorsresourceguide.com/directories/National/SHIP/
Or you can go to . . .
West Virginia http://www.wvship.org/
▪ You can visit www.Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
You can visit www.Medicare.gov/medigap-supplemental-insurance-plans to find out which insurance companies offer Medicap insurance in your state.
▪ You can visit www.Medicare.gov/plan-compare, usually starting about Oct. 1, to compare health and drug plan coverages that will be available in the new year.
If you would like to check on the quality of Medicare health and drug plans, Medicare has a star rating posted on the www.Medicare.gov/plan-compare website. The overall rating for health plans includes a look at whether plan members got screening tests, vaccines, and other check-ups to help them stay healthy; how well the plan works with members to manage chronic health conditions; the experience of members with the health plan; complaints from members; and how well the plan handles member calls and questions.