Medicare open enrollment season runs from November 15 through December 31, conveniently overlapping Thanksgiving and Christmas: Whenever parents and their adult children need a break from holiday planning, shopping, cooking, and celebrating, they can join forces to decipher the intricacies of Medicare Parts A, B, C, and D!
If you're new to Medicare, you'll want to take time to learn the jargon and compare your choices carefully.
If you're already enrolled in a Medicare plan that you like, don't breathe your sigh of relief too fast. You too should review the available choices, says the Medicare Rights Center, a consumer advocacy group. The reason: many plans change their costs and
benefits from year to year.
First, a quick overview for everyone who's just getting started:
There are two basic types of plan.
Original Medicare is the
traditional fee-for-service plan. It includes Part A (hospital coverage) and Part B (doctors' visits and outpatient services). With original Medicare, you’re covered for 80% of Medicare’s approved
fee, and you can go to any doctor who accepts Medicare. Your monthly premium for Part B depends on your income. (In most cases, there's no premium for Part A.)
The
alternative is a Medicare Advantage plan, sometimes called Medicare Part C. Medicare Advantage plans are run by private
insurers but subsidized by the government. With these plans, you must use a pre-selected network of medical providers. You pay a monthly premium in addition to your Part B premium.
Like Original Medicare, Medicare Advantage plans include Part A and Part B. But they usually also include benefits that aren't provided by Original Medicare. If you enroll in a Medicare Advantage plan, for example, your prescription drug
coverage (Part D) is included in your benefits package.
By contrast, if you opt for
Original Medicare, you must buy a stand-alone prescription drug policy.
If you enroll in Original Medicare, you may also want to consider buying a Medigap, or supplemental policy, to cover some of the Part A and Part B expenses that Original Medicare doesn't pay for. (Medigap policies cannot be used to pay for your out-of-pocket expenses in a Medicare Advantage plan.)
Medigap policies are sold by private insurers, and their cost varies depending on the policy and the insurer.
You’ll find a description of Original Medicare and Medicare Advantage, and a full list of all the Medicare Advantage plans available in your zip code at www.medicare.gov.
There's only one Original Medicare plan, but there are literally hundreds of Medicare Advantage plans.
If you're considering Medicare Advantage, here are some of the questions the Medicare Rights Center advises you to ask:
1. Will I be able to use my doctors? Are they in the plan’s
network and are they taking new patients who have this plan?
2. Which hospitals, home health agencies, and skilled nursing facility are in the plan's network?
3. How much is my monthly premium?
4. How much will it cost to see my primary care physician? How
much will it cost to see a specialist?
5. Do I need a referral to see a specialist?
6. Are there higher co-pays for certain types of care, such as
hospital stays or cancer treatment?
7. Does the plan have an annual limit on out-of-pocket costs?
Do all services count toward that out-of-pocket maximum?
8. What part of the country does the plan cover? (New York, New Jersey and Connecticut, for example.)
10. Are my prescription drugs on the plan’s ‘formulary’ -- i.e., list
of covered drugs?
11. Does the plan require that I get “prior authorization”
before my prescription will be covered? Does it impose other restrictions (like
limiting the quantity, or requiring that I try a cheaper medication before it
will cover a more expensive one)?
12. How much will I have to pay out of pocket before my coverage
starts? (In other words, what is the deductible)?
13. How much will I pay for brand-name drugs? How much for generic drugs?
For a list that includes these and more questions to ask, go to Medicare Interactive.
In I What if you decide you prefer Original Medicare? Then you'll have to comparison-shop for a stand-alone prescription drug policy. And that'll be the subject of my next post.
Please send your questions to [email protected]. I'm sorry I can't respond personally to every email. Questions are only addressed online.
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