Some seniors like to take advantage of the Medicare program.
An increasing number of people are opting to enroll in Medicare Advantage plans — and that figure is only expected to grow in the coming years, according to projections from the Congressional Budget Office and the Medicare Trustees, which analyze and report on health care trends.
Right now, nearly a third of all beneficiaries sign up for bundled coverage that combines the different portions of traditional Medicare — Part A (inpatient hospital stays, skilled nursing facilities, hospice care and some home health visits); Part B (physicians visits, preventative care services and some home health visits); and Part D (outpatient prescription drugs) — into a single policy that has provided one of the private insurance companies approved by Medicare.
So what’s the advantage of going with a Medicare Advantage (MA) plan?
“Medicare Advantage can be attractive because it may have a very low monthly premium and there may be low or no co-payments for certain types of services,” says Fred Riccardi, director of client services for the Medicare Rights Center, a non-profit that helps people access affordable health care.
Plus, Riccardi adds, they may offer some services not available in an Original Medicare plan, such as basic vision and dental care, depending on the plan.
But there are charges for other types of care that are important to understand and look at, he says.
“That could be how much it would cost to see a specialist; does an individual need a referral; are you paying for other types of care — hospital care or a nursing facility — or a deductible? It’s really important to look at those details of the plan,” Riccardi says.
Something else seniors should pay close attention to is their list of approved drug formularies and care providers. Unlike traditional Medicare, MA plans operate on a network system, meaning beneficiaries can’t just go to any pharmacy or health-care provider that accepts Medicare. They have to find ones that are in their network if they don’t want to pay additional costs out of pocket.
“Provider networks can vary widely from one plan to another,” 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.
“And if people are currently seeing providers that they want to continue to be able to see, then they want to make sure that if they’re looking at changing from one plan to another, (it’s) not going to disrupt their access.”
In other words, Medicare beneficiaries have some major decisions to make at the moment — especially if they plan on changing plans during open enrollment, which starts Oct. 15 and ends Dec. 7.
It’s the main window of time every year in which current enrollees can alter their health-care coverage without incurring any penalties. But they don’t need to worry about weighing their options alone. Instead, they can find help, either online by visiting medicare.gov, or in person by contacting their local State Health Insurance Assistance Program (SHIP). Its navigators can help individuals compare plans and answer questions about their current policy.
In New York State, SHIP services are provided through the Health Insurance Information, Counseling and Assistance Program (HIICAP). More information on HIICAP can be found at aging.ny.gov or by calling 800-701-0501.
People outside of New York State can call 800-Medicare for assistance over the phone.