As a primary care doctor at Summit Health, I know how important it is for my eligible patients to register for the Medicare plan that best suits their unique needs. My patients often ask me for guidance during the Annual Enrollment Period. While every person is different, I give my patients these four helpful tips to choose the plan that works best for their needs.
Tip #1: Check Your Coverage
Ask yourself, “How well does my plan cover the services I need?”
With Original Medicare, most medically necessary services and supplies in hospitals, doctors’ offices, and other healthcare facilities are covered, but it doesn’t cover some benefits, such as prescription coverage, eye exams or dental care. Medicare Advantage Plans cover all medically necessary services that Original Medicare covers but also offer some extra benefits, including prescription coverage, certain vision, hearing and dental services.
It is also important to check that the plan covers where you currently live.
Tip #2: Confirm Your Doctors are In-Network
It's important to confirm that your preferred doctor and pharmacy are in-network with the plan. If they are out-of-network and you continue to use them, you may have to pay more for your visits. This is also a good time to check that your current medications are covered under the plan you are considering.
Under an Original Medicare plan, all doctors who accept Medicare are considered in-network. However, under a Medicare Advantage plan, you have access to a select network of doctors.
Tip #3: Review Costs
I want to make sure my patients can avoid financial stress over healthcare costs. As much as possible, it’s important to think ahead and confirm the costs included with your coverage make the most sense for your upcoming medical needs. Looking back at your healthcare expenses from the past year and thinking through what you anticipate in the next year are helpful exercises for this step.
Some questions that may be helpful to ask yourself include:
- Did I reach my deductible?
- How much did I spend in copays at my preferred doctor’s office?
- Are there any services I anticipate needing next year? Will I need vision, dental, or hearing coverage in addition to regular hospital care?
- Were there any services I didn’t use that are part of my plan?
When we talk about healthcare expenses, I know you may hear some confusing terms. I’ve defined a few of these below:
- Deductible: A deductible is an amount of money you are responsible for paying toward medical services. With original Medicare, the deductible is a fixed amount – please visit medicare.gov for more information. With Medicare Advantage plans, the deductible cost depends on the plan you choose. You have the freedom to choose the option that best fits your lifestyle.
- Coinsurance: Coinsurance is the amount you pay for covered healthcare services after you meet your deductible. For example, if your coinsurance is 20%, you will pay $20 for a doctor’s visit that costs $100 if you have met your deductible. The insurance company pays the rest.
- Copays: A copay is a fixed amount you pay for a healthcare service once you have paid your deductible.
Tip #4: Speak with a Health Insurance Agent
Did you know you can speak with a licensed health insurance agent to prepare for Medicare Annual Enrollment? These individuals help you understand the options available to you and pick the right plan. Be sure to confirm your agent has an active license in your state.
Summit Health has partnered a trusted licensed agent. For more information, please click here.
Additionally, there are many tools you can take advantage of to learn more about Medicare. My favorite tool is the website Medicare.gov. This is the official government website for Medicare and lets you compare plans and identify which one is best for you in the coming year. Our team at Summit Health is also here to help as well to guide you through the process.
Medicare's Annual Enrollment Period can feel like an intimidating process. I hope with these four steps, you can feel confident that you’re choosing the plan that best fits your needs.
P.S. Medicare Annual Enrollment is now open. Be sure to review your coverage and make selections for next year by Saturday, December 7.