By Anuradha Mundluru, MD ~
It’s that time of year again! Medicare Annual Enrollment is open until December 7. That means it’s time to evaluate the benefits you’ve been receiving and make sure your coverage is working hard for your health needs.
With so many plans and constant policy changes, finding the perfect plan can be overwhelming. For seniors, making an uninformed decision can end up leaving you with unexpected costs.
But with some helpful insights and resources, navigating this open enrollment period can be more manageable.
Medicare Advantage, which is also known as Part C coverage, is a health plan option you have as part of your Medicare coverage. Private insurance companies operate these plans, and Medicare pays a fixed amount to these payers each month for your coverage. Medicare Advantage policies typically include coverage for your Part A and Part B insurance, which cover hospitals and medical. These plans may also cover Part D, for your medications, and some insurance companies also offer coverage for other health needs – like dental, vision, or wellness, for example.
The benefits of Medicare Advantage often boil down to lower premiums and more options for your health and prescription drug needs. This plan combines your Part A and Part B coverage into one plan that can be very useful, and in some cases, you may be able to get that coverage at a lower cost. As mentioned, prescriptions may also be covered. And finally, enrolling in a Medicare Advantage plan may reduce your need for other supplemental insurance or Medicare Supplement policies.
As you’ve likely seen, benefits can change from year to year. Providers can change which plans they work with each year. Coverage options vary based on where you live, and chances are your health is changing too. It is essential to review your coverage each year during the open enrollment period. Analyze whether you’re getting the coverage that you need from your plan, determine if your doctors will continue to participate in that plan, and make sure that your medications are covered.
With Medicare Advantage, you have the choice of two options, choosing a Preferred Provider Organization (PPO), where you have the flexibility to obtain services from providers within the plan’s network or outside of it (although with less coverage). Or a Health Maintenance Organization (HMO) plan, where you must stick within your plan’s network of providers to get maximum coverage.
What’s unique about Medicare Advantage plans is that many insurance providers also offer additional coverage for things like vision, dental, gym memberships and wellness benefits, helping offset costs you might otherwise end up paying out of pocket.
Doctors who choose to participate in this program have to follow specific processes and reporting—which is especially crucial for patients with chronic illnesses. These processes are meant to ensure your provider is providing helpful and ongoing monitoring when you have a specific health condition, like diabetes, for example or heart disease. The private insurance companies are also rated on their service using a rating system called the Star rating, and you can and should check their star rating when evaluating your options. Both of these elements are how Medicare helps to provide checks and balances on the various providers and organizations participating in Medicare Advantage plans.
When you’re taking a look at your options, be sure to start with the Medicare website at medicare.gov. There, you can find an electronic copy of the “Medicare and You,” which is published each year and provides information to help you understand the differences between traditional Medicare coverage and Medicare Advantage coverage.
It’s also worth checking with your primary care physician or your pharmacist to see if they have any helpful insights on how to make the most of your coverage.
Ultimately, it’s worth spending a little extra time to ensure you’re making an informed decision and that your plan is the right choice for you.
Taking the time to know what coverage you’re getting, making sure your doctors participate, and making sure your medications are covered will help you be confident that your insurance has you protected in the new year.
Anuradha Mundluru, MD is a board-certified internal medicine specialist based in Mesquite, TX. She received her medical degree from Kurnool Medical College and has been in practice for more than 20 years. As a local physician, she has ample clinical experience in caring for the senior population in the Dallas community, and helping them to navigate the complex workings of chronic conditions that often come with age.