Medicare can be hard to navigate, even if you’ve been enrolled for years.
As open enrollment approaches (Oct. through Dec. 7) you’ll want to pay attention to some of the most common questions that come up.
On the other hand, with Medicare Advantage, you’re faced with variable copays and deductibles depending on which plan you choose. Medicare Advantage plans have doctor networks and you are limited to visiting the doctors, hospitals and specialists in the network.
You should know the difference if you are considering moving to Medicare Advantage from Original Medicare – or vice versa. This is crucial and if you are moving to Medicare Advantage, you should check to see that your doctor is in the plan’s network.
Medicare Advantage and Medicare supplement plans are not the same thing
While Original Medicare offers more flexibility in choosing health care providers, it doesn’t cover everything. That’s why many seniors choose a Medicare supplement insurance, commonly referred to as a Medigap plan. These plans are designed to fill some of the holes in your original.
But that’s not what a Medicare Advantage plan does.
Also, because people mistake the two, they may drop their Medigap coverage when they decide to switch from Medicare to Medicare Advantage. You should know that if you make the switch, you might not be eligible to buy a Medigap plan again if you decide to return to Original Medicare.
Compare your Medicare Advantage choices
Medicare Advantage gives you a number of choices for coverage to suit your needs and budget.
Plans can vary in how they are structured, particularly in terms of copayments and deductibles and other out-of-pocket expenses. In addition, each plan will have its own network, so be careful to check that the doctors and specialists you’ve been accustomed to seeing are still on the list.
Take into account the prescription benefits, too. Make sure that the plan you choose meets your needs in terms of the prescription medications you may be taking and how much you’ll be paying out of pocket for them.
Financial assistance
Even with Medicare Part D, prescription drug costs can still be expensive, particularly if you have a condition that requires specialty drugs.
If you have limited funds, you can apply for the Extra Help program through the Social Security Administration, which estimates that the benefits are worth around $4,000 per year. You have to be enrolled in Part D to be eligible.
The takeaway
During open enrollment don’t put your plan on autopilot just because you don’t have time or if you feel the choices are too confusing. Don’t take the path of least resistance.
The best way to avoid that is by marking the open enrollment period on your calendar each year, so you can adequately prepare. The more thought you put into your Medicare needs in advance, the better the odds that you’ll settle on the plan that is right for you.
Jay is a graduate of the University of Pennsylvania School of Dental Medicine and also has an MBA from San Francisco State University. He has worked for a number of insurance carriers and brokers over the past 25 years. At UBF, Jay specializes in advocating for our clients in various issues, including grievances, benefit inquiries and eligibility issues.