In the heat of the Medicare Annual Election Period it seems choices are more confusing than ever. Ads blare out of the TV screen and mailboxes fill up with volumes of solicitations. How can you sort it all out?
You can start by taking very simple steps to help yourself or someone you love get the plan that is right for them. First things first: Exactly what part of the medical system are you using the most? Is it doctors, medications, hospitals or other services? By answering these basic questions you can prioritize what is most important. Your next door neighbor or Aunt Susan may feel their plan is the best, but that plan may not be right for you.
How to check: Medications are pretty commonly used to treat conditions. Most plans have lists of drugs they cover called “formularies”. Your first place to check would be to make sure the drugs you need to take are on that plan’s list. The second place would be how much you pay for a drug. Many plans have higher and lower co-pay levels for medications. Find out the level of co-pay each of your drugs is on. If you have many medications certain pharmacies will provide illustrations at no charge to assist you in your search.
Most people want a plan where their doctors are listed as providers, but not having a doctor on your plan is not necessarily a deal breaker. Let’s say you use a certain expensive medication you take daily and it is covered by a plan that doesn’t have one of your specialists. You may want to consider which is more important: Getting your medication or possibly paying out of pocket to see that one specialist.
Some plans have benefits like worldwide coverage. If you travel outside the U.S. frequently, having that benefit would be an important feature if you used little or few medical services other than preventive.
Some plans “buy down” the Part B premium to reduce insurance costs. However the saying is true: There is no free lunch. Plans are able to provide this money by reducing the amount they use for benefits. This may mean fewer drugs, greater hospital co-pays or less skilled nursing facility benefits. The members don’t even receive all of the benefit money that is cut, 25 percent of the unused portion goes back to the federal government, 75 percent is what is given for the “buy down.”
This year Medicare has required all Medicare Advantage plans to carry a maximum of $6,700 on out-of-pocket expenses for medical services. That does not include your drugs which have a separate out of pocket maximum. Be sure to check the ‘evidence of coverage’ you receive after you have signed up for the plan to see which costs are allocated to the maximum out of pocket.
Always remember it’s you or your family member is who is using the plan, not your next door neighbor. Tailor your benefit program to what you use.
Betsy Vipond is CEO of The Senior Health Advisor and has been in insurance for more than 32 years. She specializes in Medicare products.