Tips for Navigating Medicare
Know the Parts. Medicare is a government-run health insurance program for those 65 or older and those with certain disabilities. It has several parts. Part A covers inpatient services, including hospital stays, while Part B covers outpatient medical services, such as doctor visits. Together, Parts A and B are sometimes referred to as "Original Medicare." Most people choose additional insurance to pay expenses not covered by Original Medicare. One option is Medicare Part C, also known as Medicare Advantage (MA), which combines Parts A and B into a single plan run by private insurance companies. Members may add Part D (prescription drug) to their MA plan to have one source for all of their health care coverage. More than 13 million Americans, or roughly 26 percent of all Medicare beneficiaries, have chosen to enroll in a MA plan. These plans may include additional premiums.
Mark your Calendar. As mentioned, AEP is when most people pick or change plans. Once a plan is selected, they might not be able to change it for a year, with a few exceptions. A "disenrollment period" occurs between January 1 and February 14 when members can disenroll from a MA plan, return to Original Medicare, and add or drop drug coverage. Additionally, there are "special election periods" for those who qualify because of factors such as losing their plan or moving to a new area.
Check for Changes. People who already have a Medicare plan receive a document by September 30 known as the Annual Notice of Change or ANOC. The ANOC lists changes to the plan for the upcoming year. It's important for members to take note of these changes and how they will impact their cost and coverage. Those who are OK with the changes can keep their coverage by taking no action.
Shop Around. People who are thinking about changing their coverage should shop around. MA premiums, benefits and special offers vary by plan so there is a lot to compare.
- Different plans have different drug lists, known as formularies, which dictate drug costs. Members should check to see where their prescriptions fall on these lists, particularly if they've gotten new prescriptions since they picked their plan. Additionally, plans may offer coverage during Medicare's coverage gap.
- Members should check to see if their favorite hospitals, doctors and pharmacies are included in a MA plan's network. Costs generally increase when members go outside their network for care.
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- Weigh not only the plan's monthly premium, but other out-of- pocket costs, such as copays, coinsurance and out-of-pocket maximums.
- Additional programs may be available through a MA plan, including gym memberships, nurse health lines, care coordination for people with certain chronic conditions and discounts on retail products. If not included in the plan, you may be able to purchase things like vision and dental coverage at an additional cost.
Get comfortable. Companies like Anthem try to meet people wherever they are most comfortable. Agents can talk to applicants over the telephone or come to their homes. They also are available at some retail store locations and at community sales seminars. The technologically inclined can visit online stores.
Inquire about extra help. Some beneficiaries with limited income may qualify for "extra help" to pay prescription drug costs, such as premiums, deductibles and coinsurance. Visit the Social Security website or call the Social Security Administration at 1-800-772- 1213 (TTY 1-800-325-0778) for details. Applicants also will be screened for state programs that could help with other Medicare costs.