With October on the horizon, it’s time for seniors to prepare for that annual checkup – on their health, as well as existing health insurance plans.
“Ask yourself ‘Is my current plan meeting my needs or is there something better out there?’ You want to maximize your coverage and dollars, and make sure you’re in the right plan for you,” says Tom Gilsdorf, director, Medicare Advantage Business Unit, Blue Cross and Blue Shield of Nebraska (BCBSNE).
Medicare’s annual open enrollment period is Oct. 15–Dec. 7 (for a Jan. 1 effective date). During that time and without too much restriction, seniors 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.
“With Original Medicare, there are no caps or limits in terms of out-of-pocket spending. That’s another reason why someone might get a Medicare Advantage plan or Medicare supplemental insurance (Medigap),” says Stephanie Roy, BCBSNE’s senior market marketing lead.
To start the checkup process – should you make changes to your existing coverage or enroll in Medicare to begin with? – consider these five questions:
Q. Do you need health insurance and are you eligible for Medicare?
Most individuals become eligible for Original Medicare at age 65. Initial enrollment runs for seven months surrounding your 65th birthday with another opportunity for entry between Jan. 1 and March 31 each year.
Before enrolling, make sure you’re aware of all avenues of coverage that are available to you post-retirement. Does your employer or union sponsor a retiree health plan? Are you eligible for veteran’s benefits?
Beyond that, your decision to enroll in Original Medicare, Medicare Advantage or another private plan may depend on your health needs and:
- A desire to remain with your current doctors and hospitals.
- The ability to visit a specialist without going through a primary care physician.
- Being able to stay with your pharmacy of choice.
- Your budget – how much can you or do you want to pay monthly or annually?
“It’s about finding that sweet spot based on your particular needs and your particular budget,” Gilsdorf says. “Would you rather pre-pay for services, through a higher premium, where you know everything is covered – or do you want to pay-as-you go with office visit co-pays and a few out-of-pocket costs in return for a lower monthly premium?”
Q. What prescriptions do you have or expect to need in the future?
If you determine you would benefit from Medicare Part D, use Medicare’s online Plan Finder to zero-in on the prescription drug plan that’s right for you. Plug in your zip code and the drugs you’re taking, and “it will come up with the best plan for your money in your zip code,” Gilsdorf says.
Q. Are you interested in coverage Original Medicare doesn’t offer, such as vision, dental and/or hearing?
Many Medicare Advantage plans provide some level of coverage for dental, vision and hearing. Many also offer a fitness benefit and/or an over-the-counter benefit for items, such as cough medicine, bandages and vitamins, that aren’t typically covered.
Roy recommends taking time to list benefit priorities that go beyond Original Medicare: “That way, when you have a conversation with an adviser or a broker, you can be prepared to say, ‘These are the things I’m looking for in my Medicare Advantage plan.’”
Q. Would you like a plan that covers you when you travel?
When traveling inside the United States, most doctors and hospital participate in the Original Medicare program. “Any doctor who accepts Medicare is covered; there really is no network of doctors and hospitals,” Gilsdorf says. With Medicare Advantage, a network is typically involved. But some Medicare Advantage plans have additional benefits that cover things like travel.
For international travel, Gilsdorf says a Medicare Advantage plan carries broader benefits, including up to $50,000 in benefits for emergency care and transportation. Even so, he recommends supplementing with a travel benefit plan, such as GeoBlue, to fill any gaps while you’re abroad.
Q. Do you need help finding the right plan?
“No one turns 65 and suddenly becomes an expert on Medicare,” Gilsdorf says.“You really do need to do your research and get in touch with a trusted adviser.”
To find an insurance agent or adviser who can help you navigate your Medicare decisions, check out BCBSNE’s Find an Agent page.
“It’s one of the most important decision you’ll make,” Gilsdorf says, “and you want to make the right decision for you.”
For more information about Medicare plans, visit Medicare.NebraskaBlue.com.