Whether you are new to Medicare or a veteran member, you need to take the time to review your plan options to ensure your chosen plan both meets your medical needs and fits your budget.
Note that plans change each year; out-of-pocket costs typically rise, providers may leave networks, and drug formularies often add or remove covered prescriptions. Of course, your own needs may change from year to year, as well.
With so many options, Medicare confuses many people. A bit of time and research go a long way toward ensuring you make the most of your Medicare benefits.
Make an Assessment of Your Current Medicare Plan
Assessing your current plan actually starts with assessing your healthcare needs, including future expectations. Until you do this, it is very difficult to understand the level of coverage you need. When conducting this assessment, do not forget to consider your prescription needs.
Look also at expected doctor appointments. In addition to your yearly wellness visit, do you expect to visit any specialists? Did your last checkup include recommendations or warnings of potential future issues? The answers to questions like these will help you determine whether your prescription or specialist needs will change.
Finally, take a hard look at your budget, including what you spent on healthcare last year.
Be Aware of Plan Interruptions
If your current plan will not be available next year, you receive a non-renewal notice or plan disruption letter. This does not mean you lose current coverage. However, during open enrollment you must choose a new plan. If this happens to you, be sure to talk to your Medicare Solutions Licensed Sales Agent as soon as possible about your plan options.
Take Advantage of Preventive Medicare Coverage
Like providers and insurers across the country, Medicare recognizes the value and importance of preventive care. In the same way regular oil changes and tire rotations help protect you from expensive car repairs, preventive healthcare helps discover issues early, while easier to treat.
Medicare Part B is the medical portion of your coverage. Medicare Advantage plans include everything covered by Part B, including the following preventive care items.
The Welcome to Medicare preventive visit occurs during your first year as a Medicare beneficiary. During this visit, your provider:
- Reviews your complete medical history
- Reviews your social history as it relates to health (smoking, drinking, etc.)
- Provides educational materials regarding preventive services, such as shots and screenings
When you make this appointment, be sure to schedule enough time to review these components in detail. The visit carries no co-pay, although referrals to specialists may, and certain screenings or tests may.
After 12 months receiving Medicare benefits, you qualify for a yearly wellness visit, also free of a co-pay. Similar to the Welcome to Medicare visit, this consultation includes a Health Risk Assessment.
Medicare covers one cardiovascular disease behavioral therapy appointment every 12 months with no out-of-pocket expense. It includes a blood pressure check and an assessment of your risk of developing cardiovascular disease. In addition, your physician provides educational materials and advice regarding diet and exercise.
Women over age 40 receive one mammogram every 12 months, free of charge as long as the provider accepts assignment. If your physician deems it necessary, Medicare covers subsequent mammograms within a 12-month period at 80 percent.
If you do not meet alcohol dependency criteria but your physician feels you misuse alcohol, your Medicare coverage includes one alcohol misuse screening annually, as well as up to four counseling sessions performed in a primary care setting. Both the screening and counseling session carry no out-of-pocket expense.
Do Not Forget Gap Coverage
Gaps in your original Medicare coverage may expose you to unexpected medical expenses. A Medicare Supplement insurance policy, sometimes called a Medigap plan, helps protect you against this. The most common ancillary insurance plans are dental and vision insurance, as original Medicare does not include this coverage. Other popular plans include critical illness and cancer insurance, which provide reimbursement for catastrophic illness and cancer diagnoses.
Note that you cannot use Medigap and Medicare Advantage simultaneously. Unless you switch to Original Medicare, it is illegal for anyone to sell you a Medigap plan.
Medicare offers a variety of special benefits for certain conditions and situations. Explore the Medicare site for a full list. Some of these include:
- Do you have diabetes? You may qualify for two free fasting plasma glucose screenings every 12 months.
- Discount programs abound, including weight loss and chiropractic services. Look at your specific plan for a full list of available programs.
- Do not ignore messages from Medicare or your provider; these often inform you of coming changes in coverage.
- Pay attention to the drug formulary’s preferred brands. If your doctor prescribes a drug not on that list, ask him or her about a substitution to save yourself some money.
- If you have prescriptions not covered by your plan, consider a discount drug card. Be sure to look at fees for the card and compare them to the cost of simply paying the full cost of the prescription.
- Do you have coverage through an employer, or a former employer? Spouse? Union? If so, compare Medicare coverage with this plan to determine which is best. If there is a lot of overlap, you probably only need one of them.
It takes some time to be an informed consumer, but it offers tremendous savings. You also take better control of your health.