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  • Cameron Oglesby

Are you about to make a Medicare mistake?

Updated: Oct 4


It’s almost that time of year again. A little over two weeks from now, Medicare’s open enrollment period (officially known as the Medicare Annual Election Period) will start.


Some 54,100,000 Americans 65 and older will once again get bombarded by junk mail and digital advertising urging them to choose one of literally thousands of Medicare options – including Original Medicare, Medicare Supplement, Medicare Advantage, and Medicare Prescription Drug plans.


With such a wealth of choices, making the wrong one is all too easy – particularly if you make one of these all too common Medicare mistakes:


Mistake #1: Choosing the wrong type of plan.


Before you can choose the type of plan (or combination of plans) that best fits your needs and your way of living, you need to understand how each type works and the differences between them.


Original Medicare is a government-run plan. It covers care from all providers who agree to accept Medicare payments (which are often lower than their normal fees for service). There’s no charge for Part A (hospital coverage), and a monthly charge for Part B (doctor care) gets deducted from your Social Security payments. It comes with co-payments and deductibles.


Medicare Supplement is a private insurance policy that makes up the difference between what healthcare providers charge and what Original Medicare reimburses. How much of that difference a Medicare Supplement covers can vary from plan to plan. You pay a monthly or annual premium.


Neither Medicare Parts A and B nor Medicare Supplement covers prescription drugs. Under Part D, a standalone Prescription Drug Plan, from a private insurer, can. Premiums vary from plan to plan, and co-pays vary according to the plan and the specific med(s).


Medicare Advantage Plans, too, are offered by private insurers. In addition to doctor and hospital care, they offer dental, vision, hearing, transportation, and wellness benefits such as health club memberships. Most offer prescription drug coverage. Some charge co-pays for primary care and specialist visits, as well for lab work and other benefits.


Mistake #2: Failing to check the plan’s network


If there are doctors and specialists you’ve been seeing, if there are certain hospitals you’d prefer, you need to check whether they’re in your preferred plan’s network. With Original Medicare, that shouldn’t be a problem, because most providers accept Medicare payments. A simple phone call can tell you whether yours do.


Medicare Advantage Plans, on the other hand, are set up on an HMO or PPO model. This means that if you see a provider outside the plan’s network (except for emergencies), you’ll be charged a higher out-of-network co-pay or not be covered at all. So if there's an Advantage Plan you’re considering, check out the provider network, either online of by requesting a printed provider list.


Mistake #3: Failing to check the plan’s geography


Being government-run, Original Medicare is national in scope, so no worries if you need a doctor while traveling.


But not all Advantage Plans are. Some are nationwide, some regional, and some are local down to the county level. Some are affiliated with nationwide pharmacy chains, and some aren’t.


If you get sick or injured while traveling, regional and local plans will automatically cover urgent care and emergency room visits, but not necessarily anything else. And if you need to refill a prescription on the road, you may find yourself having to pay an out-of-system pharmacy full price for your meds.


If you’re a homebody, no problem. But if you’re a snowbird, or if you like to travel a lot, you need to make sure your Advantage Plan will go wherever you do.


Mistake #4: Basing your choice on monthly premium alone


Many Advantage Plans charge zero monthly premiums. Some make up the difference elsewhere, with higher co-pays and/or higher out-of-pocket maximums. Others have zero- and monthly-premium versions, with the main difference being a wider provider network. Some plans have no co-pays for primary care physician and specialist visits, wile some charge for either or both. Some give you a higher allowance for new glasses or dental work than others. Some plans classify prescription drugs differently in their formularies, so co-pays can differ.


If cost is what you’re concerned about, it pays to consider total cost. So don’t just check the premiums. Check the co-pays for doctor visits, lab work, and other coverages and the prescription drug formularies. Compare their coverage with your own health needs. Then, and only then, decide.


Mistake #5: Renewing your plan on autopilot


If you’re happy with the plan you have now, that’s great. But most plans, even including Original Medicare, make changes from year to year. Co-pays and out-of-pocket maximums can go up or down. New benefits can be added, and old ones changed. Generic prescription drugs can move to a higher or lower tier in the formulary, which will affect the cost you pay for them. So when your plan’s Annual Notice of Change arrives in the mail, make sure you read it. If you see changes you don’t like, you have until December 7 to switch.


Mistake #6: Asking too few questions


Your Medicare plan should fit not only your health needs and budget, but also your preferences and your way of living. So ask around before you commit. Talk to your doctor, your plan’s customer service department, a Medicare Advantage Plan broker, your friends and relatives who have Medicare coverage. No type of Medicare plan is one-size-fits-all, so the more you ask around, the better your chance of choosing the plan that fits you.


Mistake #7: Ignoring your plan’s benefits


One of the main factors in choosing a Medicare plan is its benefits, so take advantage of them. Go for the screenings, get the vaccines, see the doctor for your annual wellness visit, get your eyes, hearing and teeth checked, and get and use that health club membership. You’ll feel a lot better – and not just as a matter of health.


Different people have different needs. That’s true not for just Medicare coverage, but for life in general. Different people have different family and social relationships, different emotional outlooks, different lifestyles, different interests, priorities, and values.


That’s why, before anything else, we ask around, by way of a thorough three-part assessment of a client’s physical, emotional, cognitive, and psychosocial care needs. The personal, inner, information we learn becomes the basis of a custom-tailored, coordinated plan that provides exactly the care our client needs to keep living as independently as possible, in the lifestyle they prefer, for as long as possible.


Please contact us to learn more about what a difference that can make.

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