Did you know you have choices for Part D/prescription drug coverage, Traditional/Original Medicare coverage or opting for Medicare Advantage/Part C/Managed Care Medicare — which are approved plans from private insurance companies?
Medicare’s open enrollment begins Sunday and continues through Dec 7. During this time, there are critical decisions that Medicare enrollees need to assess and make for the next year.
Plans can change from year to year and your health needs may change too.
When comparing Traditional/Original Medicare/TM against each Medicare Advantage/MA plan, Medicare.gov has outlined some questions to ask for comparison:
- Can I get my health care from any doctor, other healthcare provider or hospital?
- Are my prescriptions covered?
- What are my costs?
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Other areas to research in making a final decision:
- MA plans are sold ‘per county’. The in-network coverage should be made very clear as out-of-network penalties can be significant. However emergency care for MA plans is covered as in-network.
- TM is nationwide with no network limitations.
- Out-of-pocket costs are different between each MA plan. The out-of-pocket expenses for Traditional/Original Medicare are different than the Medicare Advantage
- plans. Be sure to include and assess any chronic condition costs, all prescription drug costs along with access to preferred providers and their costs.
The MA plans have supplemental benefits that TM does not offer. Each MA plan has their own list and many are offering new benefits for 2024. If you are part of an existing MA plan, the plan should send a highlight outline of changes which can be very helpful in evaluating staying with your current MA, changing to a new MA plan, or going back to TM. All doable during the open enrollment period.
Start at Medicare.gov, the official source to find the type of coverage that fits you best. To compare options, simply create your own personal file, insert the zip code you are interested in evaluating the MA plans that are being sold there and both Part D/stand -alone plans sold with TM and all MA plans.
If you need additional assistance, call 1-800-Medicare during open enrollment. Another great source is your local State Health Insurance Assistance Program (SHIP). Go online to shiphelp.org to get the phone number for your state.
Need financial assistance?
If you make less than $22,000 a year ($30,000 for married couples), it’s worth applying for ‘Extra Help.”
Extra help can pay your prescription drug coverage/Part D premiums, deductibles, coinsurance and other costs. Visit ssa.gov/extrahelp or call Social Security at 1-800-772-1212 to apply for Extra Help.
Day Egusquiza is the president and founder of the Patient Financial Navigator Foundation Inc. — an Idaho-based family foundation. For more information, call 208-423-9036 or go to pfnfinc.com. Do you have a topic for Health Care Buzz? Please share at email@example.com.
Medicare’s open enrollment begins Sunday and continues through Dec 7. During this time, there are critical decisions that Medicare enrollees need to assess and make for the next year. Plans can change from year to year and your health needs may change too.
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