Guide to Medicare: Now’s time to find the best health coverage

Guide to Medicare: Now’s time to find the best health coverage


Do-overs don’t come around often in life. But that’s exactly what the Medicare annual open enrollment period — Oct. 15 to Dec. 7 — is for the one in five Americans currently receiving health care coverage through the program.


“This is the time of year to compare your coverage and to make changes,” says Fred Riccardi, director of client services for the Medicare Rights Center, a non-profit that helps people access affordable health care.


It’s one of the few windows of time in which current Medicare beneficiaries can alter their insurance plans without being penalized.


The first step is to review your Annual Notice of Change (ANOC). Every fall, insurance providers are required to inform everyone enrolled in Medicare through one of their plans of any changes to their coverage, service area or cost that will go into effect starting Jan. 1 of the following year.

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Then, “an important thing for people to consider is whether they’re happy with the coverage that they currently have and whether it’s meeting their needs,” says Juliette Cubanski, associate director of the program on Medicare Policy at the Henry J. Kaiser Family Foundation, a non-profit organization that analyzes health policy.


“If it’s not, really the best advice is for people to take a look at the plans that are going to be available in their area for the coming year.”


Plans fall into one of two categories: traditional Medicare, known as Original Medicare, or Medicare Advantage. One of the biggest decisions beneficiaries face during open enrollment is whether they should switch from one type to the other. Right now, approximately two-thirds opt to take the traditional route and sign up for an insurance policy that breaks their coverage into three parts: Part A (in-patient hospital stays, skilled nursing facilities, hospice care and some home health visits); Part B (physician visits, preventative care services and some home health visits); and Part D (outpatient prescription drugs).


“In traditional Medicare, there are no networks,” says Cubanski. “For the most part, doctors, hospitals and other health care providers will see Medicare patients. That’s really the big difference between traditional Medicare and Medicare Advantage that people need to be very aware of when they’re making decisions: Medicare Advantage Plans do have networks of providers, and if you see a provider who’s not in your plan’s network, you may face much higher out-of-pocket costs for your health care needs than if you stick within the provider’s network.

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“If your plan has a rather narrow network, that could really limit your choices in terms of the doctors that you’re able to see,” Cubanski adds.


On the other hand, an Advantage plan does streamline your insurance by bundling primary care physicians, hospitals, specialists and drug formularies under one premium and co-pay.


And an increasing number of Medicare recipients (about one in three at the moment) prefer these network-based plans.


“Looking at projections from the Congressional Budget Office and from the Medicare Trustees…enrollment in Medicare Advantage will continue to increase in the coming years,” Cubanksi says.

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Ultimately, deciding whether to enroll in one type of plan versus the other is a personal choice everyone has to make for him or herself.


But before they do, Riccardi recommends Medicare-eligible individuals take some time to shop around “because beneficiaries may be able to save money by comparing plans,” he says.


“There are a variety of ways to access information.”


A few ways to go about it are by going online to medicare.gov/planfinder to consider different plans in your service area; calling 1-800-Medicare and speaking to a representative that can go over your plan choices with you over the phone; or scheduling an in-person appointment at a State Health Insurance Assistance Program (SHIP), which is known as HIICAP (the Health Insurance Information, Counseling and Assistance Program) in New York State. More information on HIICAP can be found at aging.ny.gov or 1-800-701-0501.

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“We also have the Medicare Rights Helpline (1-800-333-4114),” Riccardi says. “So people do have resources out there to help them choose. The goal is to have people avoid throwing up their hands.”


In addition to asking for help, Riccardi strongly urges seniors 65 and over to seek out information about Medicare supplement plans, which could cut costs even more for individuals living on a fixed or limited income.


“If a person is having trouble affording their Medicare premiums or paying for their Medicare coverage services, there is help out there,” he says.


“There are benefits that help them afford their premiums and prescription drugs — that could be a Medicare Savings Program. In New York State, we have the state pharmaceutical assistance program called EPIC, and that can lower the cost of prescription drugs.”


More information on financial resources can be found at medicare.gov or health.ny.gov.

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