Nobody turns 65 and automatically becomes an expert on the intricacies of Medicare. Navigating the system can be overwhelming, especially this time of year, during the annual open enrollment period.
From now until Dec. 7, those already in a Medicare plan can:
- Switch between Original Medicare, which includes Medicare Part A (hospital coverage) and Part B (medical coverage), and a privately-offered Medicare Advantage plan (Part C), which includes both Parts A and B and can include prescription drug, dental, vision and other benefits.
- Switch from one Medicare Advantage plan to another.
- Switch between Medicare Part D (prescription drug) plans.
If you’re in the thick of evaluating plans, here are expert insights from Tom Gilsdorf, director of Blue Cross and Blue Shield of Nebraska’s Medicare Advantage business unit.
Q. What factors should I take into account when deciding whether to enroll in or switch between Original Medicare, Medicare Advantage or another private plan?
A. Gilsdorf says it may depend on your health needs and:
- A desire to remain with your current doctors, hospital and/or pharmacy-of-choice.
- The ability to visit a specialist without going through a primary care physician.
- Your budget – how much can you or do you want to pay monthly or annually?
- Your benefit priorities that go beyond Original Medicare, such as vision, dental and hearing coverage.
Q. How much does the average Medicare recipient pay out-of-pocket for medical coverage and expenses?
A. “Original Medicare pays about 80 percent of your medical expenses, meaning you are responsible for the other 20 percent, which includes your prescription drug costs,” Gilsdorf says.
A Kaiser Family Foundation study found that Medicare recipients spend about $5,503 in total, out-of-pocket. (Total out-of-pocket health care spending includes services and premiums for Medicare and private health insurance premiums.)
Q. What about Medicare Advantage plan costs?
A. While Medicare Advantage plans can have $0 or low premiums, there are often co-pays and other expenses that you’ll need to consider.
“You will still pay your Part B premium, but many times your prescription drug coverage is included in your Medicare Advantage plan. Because of this, it is important to look at your prescription drugs and determine which plan is best for you,” Gilsdorf says.
The median out-of-pocket amount for Medicare Advantage plans in 2016 was $5,800. The average Medicare Advantage plan that included prescription drug coverage in 2018 cost about $34 a month.
Q. What are the additional benefits that can come with Medicare Advantage coverage?
A. A lot of today’s Medicare Advantage plans provide at least some level of coverage for dental, vision and hearing. Some also include fitness, travel and/or over-the-counter benefits.
“One benefit of a Medicare Advantage plan is that, while you still enroll in Parts A and B, you receive all benefits through one private insurance plan rather than through Original Medicare. In other words, one card helps you access all of your benefits,” Gilsdorf explains.
Q. When can I join a Medicare Prescription Drug Plan?
A. You have a seven-month initial enrollment period: three months prior to your 65th birthday, the month of your birthday and three months after it. You can join or drop a plan during the annual enrollment period, too. Use Medicare’s online Plan Finder to zero-in on the prescription drug plan that’s right for you.
Q. What is a Medicare Supplement Insurance Plan?
A. A Medicare Supplement Insurance plan picks up where Original Medicare leaves off. These plans are designed to help pay the deductibles, copayments, and coinsurance you would normally have to pay yourself. Blue Cross and Blue Shield of Nebraska offers seven standardized plans.
Q. Where can I get help figuring out Medicare?
A. “A licensed agent can help you,” Gilsdorf says. “The good news is you have a lot of options when it comes to Medicare coverages, but you likely will need help sorting them out and picking the one that makes the most sense for you.”
To find an insurance agent or advisor who can help you navigate your Medicare decisions and answer additional questions, check out Blue Cross and Blue Shield of Nebraska’s Find an Agent page.