The 2018 version of the government’s “Medicare & You” publication has begun arriving in mailboxes, a sign that open enrollment is right around the corner. The annual enrollment period for Medicare beneficiaries runs from October 15 to December 7 each year.
“I’m not sure all seniors realize this is the one time [each year] they have an opportunity to make sure they have the right plan,” says Chris Abbott, CEO of UnitedHealthcare Medicare & Retirement in Texas and Oklahoma.
[Read: Medicare Enrollment Deadlines You Shouldn’t Miss.]
Seniors and other Medicare beneficiaries can switch between original Medicare, administered directly by the government, and Medicare Advantage, which is offered by private health insurance companies. Those who want to move between Medicare Advantage plans can do that during this time as well.
To ensure you end up with the right plan next year, ask yourself the following questions and let the answers guide your enrollment decisions.
1. Did you have problems with your plan last year?
Medicare options can be overwhelming, so the best place to start is by considering your current plan. Seniors who had a positive Medicare experience last year may have little reason to change coverage, assuming there have been no significant changes to the plan benefits or their personal situation. If your current plan isn’t meeting your needs, now is the time to make changes. “There are lots of high-quality choices out there,” says Nancy Cocozza, senior vice president and head of Aetna’s Medicare business. To find a better plan, Cocozza recommends seniors start by comparing star ratings listed on the Medicare website.
2. Can you afford your current plan?
Even if you love your plan, consider how it fits into your budget. To do that, look beyond the monthly premium price, says Chris Alberta, owner of Principium Tactical Wealth Management in Brighton, Michigan. Remember to calculate co-pays, deductibles and prescription drug coverage costs as well. Sometimes your initial Medicare plan offers more benefits than you use. “You bought a Cadillac when all you need is a good quality Chevy,” Abbott says. Check to see if a less expensive plan would be a better fit for you.
3. Do you want supplemental coverage?
When initially enrolling in Medicare Part B, the government provides six months to purchase supplemental, or Medigap, plans with no medical questions asked. Someone who switches to Medicare Advantage has a 12-month period in which they can switch back to original Medicare and resume their supplemental policy without any medical underwriting. However, that option disappears after 12 months on Medicare Advantage. For seniors who are thinking about leaving Medicare Advantage and want a supplemental plan, Alberta suggests, “Let’s make sure you can get coverage before dis-enrolling.”
4. How much traveling will you do next year?
Original Medicare can be used nationwide at any provider who accepts Medicare. However, Medicare Advantage plans typically have networks that limit coverage to a specific geographic area. That limitation has meant seniors who travel frequently often opt for original Medicare. However, some providers are experimenting with portable PPOs that offer coverage options for travelers.
5. Were you recently diagnosed with a new illness?
Anyone diagnosed with a new condition should confirm that their expected providers and prescriptions will be covered under their current plan. If not, it’s time to start looking for a new policy. Some companies offer case management or other services intended to help patients manage certain conditions such as diabetes or hypertension. Those with chronic or serious ailments may want to look for plans with this feature.
6. Will you need dental or vision coverage?
Original Medicare doesn’t cover all of the services older people need. “A lot of people are surprised when they come to Medicare and realize original Medicare doesn’t come with dental, with vision, with hearing aids, with fitness programs,” Abbott says. However, Medicare Advantage plans sometimes include these benefits.
[See: 10 Medical Services Medicare Doesn’t Cover.]
7. Do you need a separate prescription drug plan?
Those with original Medicare will need to purchase a separate prescription drug policy, known as a Part D plan. There’s also a premium surcharge if you have large gaps in your prescription drug coverage after becoming eligible for Medicare. Medicare Advantage plans sometimes include prescription drug coverage, but that doesn’t mean it will cover the medications you need. “Sometimes, the Part D plan baked into it isn’t right at all,” Alberta says.
8. Are your prescriptions covered?
Every Medicare Part D plan has a formulary that lists the prescriptions covered by the plan. It may include multiple tiers that charge higher copays for more expensive or brand name drugs. Make sure that the Part D plan you select covers the medications you need at a price you can afford. You might need to switch Part D plans as your medication needs change.
[See: 12 Free Preventive Services Medicare Provides.]
9. Do you need help finding the right plan?
Just as people seek advisors to help them plan their finances, there are agents who can help clients select the best Medicare option possible. While these agents can be helpful for anyone, they may be especially useful for those facing a serious illness or with extensive prescription drug needs.
To find the best agent, Alberta suggests looking for someone who specializes in Medicare and has experience with a number of insurance companies and products. “The last thing you want to do is work with an agent who only works with one client,” he says. In that case, chances are a person will be directed to the client’s product rather than the best plan possible.
Medicare open enrollment provides a chance to switch into a plan that better meets your needs. Use these questions to ensure you don’t squander your opportunity to find a better plan.
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9 Questions to Ask Yourself During Medicare Open Enrollment originally appeared on usnews.com
