5 tips to consider when choosing your Medicare coverage

Medicare Annual Enrollment, which runs from Oct. 15 to Dec. 7 each year, is a time when Arizonans who are 65 and older will be enrolling in Medicare for the first time or will be able to change their Medicare coverage. Many may feel confused about Medicare plans, options, and what to ask for and expect, especially in the COVID-19 era. Choosing the right plan can have a huge impact on older adult’s overall health and well-being.

Whether enrolling for the first time or re-enrolling in coverage, the following 5 tips can serve as a guide for navigating the Medicare enrollment process, so you can make the most informed decisions.

Tip 1: Review Costs and Finances.

The coronavirus pandemic has resulted in unpredictable changes in many people’s personal finances. It’s important to review whether your finances have been impacted by the coronavirus or other factors, so you can determine whether your monthly plan premium will fit into your budget. Ask yourself if you can pay your plan’s deductibles, copays and coinsurance amounts. Also, see if your medications are covered by the plan. Even if you don’t expect to change plans, it’s important to make sure your drugs will still be covered. Which brings us to the next tip!

Tip 2: Specialty Benefits.

For Medicare beneficiaries, some may be surprised that Original Medicare doesn’t cover prescription drugs and most dental, vision and hearing services, but many Medicare Advantage plans do. According to the Centers for Medicare & Medicaid Services, if you’re enrolling or re-enrolling, ask yourself if your Medicare plan covers your current health care needs and whether any of the plan changes for the upcoming year will impact you. If you’re looking for help covering the costs of your medications, choose either a Part D plan or Medicare Advantage plan with prescription coverage.

Tip 3: Know the ABCs and D of Medicare.

Medicare has four main parts – A, B, C and D. It’s important to know what is covered in each of these parts, so you feel confident in your choices.

Original Medicare includes Parts A and B.

• Part A covers in-patient care in hospitals and skilled nursing facilities, as well as hospice care and some home health care while Part B covers doctor visits and also includes outpatient hospital services, some home health services, durable medical equipment and some preventive health care. Generally speaking, Part B covers about 80 percent of a person’s health care costs, leaving them to cover the remaining 20 percent out of pocket. There’s no annual limit on out-of-pocket costs for Parts A and B.

• Part C, which is also known as Medicare Advantage, combines Parts A and B into one plan and often includes prescription drug coverage and other benefits and features not included in Original Medicare such as vision, hearing and dental care, gym memberships, disease management programs, 24/7 access to health care professionals. Medicare Advantage plans can also cover more extra benefits than they have in the past, including services like transportation to doctor visits, over-the-counter drugs, adult day-care services, and other health-related services that promote your health and wellness. These plans are offered by private health insurance companies.

• Part D helps with the cost of prescription drugs. You can enroll in a stand-alone Part D plan, although most Medicare Advantage plans also include prescription drug coverage. In addition to the four main parts of Medicare, there’s also what’s known as Medicare supplement plans, which are sometimes referred to as “Medigap plans.” These plans help cover some of the costs that Medicare Parts A and B don’t pay, such as coinsurance, copayments and deductibles.

Tip 4: Ensure 24/7 Telehealth Coverage.

Telehealth allows you to see your doctor virtually, from the safety and comfort of your home. Telehealth wasn’t new prior to COVID-19, but fewer people were using it before the pandemic. Now, many health insurance plans have encouraged the use of virtual visits as an alternative to visiting health care facilities in person, especially for older adults. In addition to convenience, more telehealth services may be covered than you might think — such as depression screenings and tobacco-use counseling. In March, the Centers for Medicare & Medicaid Services (CMS) expanded even more Medicare coverage to include 85 additional services provided via telehealth, including speech and hearing therapy, plus self-care management training. 

Tip 5: Ask About Well-Being Programs.

Many Medicare Advantage plans offer benefits, programs and resources that can help them in their efforts to live a healthy life. Medicare Advantage plans often offer programs which provide access to wellness and fitness benefits from access to participating gyms and fitness locations at no additional cost, to the perk of working with a personal trainer to create a personalized fitness plan, and even online brain health programs.

 

Dr. Tara Ostrom is associate medical director with OptumCare Primary Care.