“Have you had your annual check-up yet?” No, not with your doctor, but with your health insurance plan!
October 15 – December 7, 2019 is the open enrollment period for making changes to your Medicare Plans. It’s a great time to see if your current plans still meet your needs, or if changes in your health, doctors or medications might mean that you need to re-evaluate other options.
Traditional Medicare pays about 80% of the allowed cost for hospitalizations, tests and doctor visits. Most people with traditional Medicare also elect to purchase a Medicare Supplement Plan (also called a Medigap plan) to cover the other 20% that Medicare doesn’t pay. Traditional Medicare doesn’t usually require prior authorizations for tests or procedures, and there are no “networks” to worry about. The Supplemental Plans generally only pay for charges that Medicare has paid first; most supplements get the claim directly from Medicare along with the Explanation of Benefits that Medicare paid. Depending on the options you pick in the supplement, you may have co-pays or even deductibles, and the supplement may or may not pay your annual Medicare deductible. For 2020, the annual Medicare deductible is projected to increase to $197 (up from $185 in 2019). If your supplemental plan doesn’t cover this, you can expect to receive a bill from the first office visit or two that you schedule early in the year. Traditional Medicare is projected to cost about $144.30 per month for most people, an increase of $8.80 from 2019 rates. Most of us never see a bill for that premium, as it is usually deducted directly from your monthly Social Security payment.
Medicare Part “D” is your prescription drug plan, and it is available from commercial insurance companies. The prescription drug plans vary in coverages, preferred pharmacies, and the medications they cover. Monthly costs for these plans vary based on the coverages you pick.
Some people choose to select a “Medicare Advantage Plan” offered by a commercial insurance company (e.g., AARP, United Healthcare, BCBS, Aetna, Humana, etc.). These plans roll together the coverages that Medicare and the supplements provide, and often include other features such as vision, dental, prescription drugs and even gym memberships! Some have no additional premium charges, but, remember that you are still paying the underlying Medicare cost of $144.30, so the Medicare Advantage plans are not “free”. When considering if a Medicare Advantage Plan may be right for you, be sure you understand the differences between an HMO and a PPO plan. HMOs will restrict you to doctors, hospitals and other facilities in their networks. That may be fine, as long as your Primary Care Doctor is in the network and you are generally healthy and don’t go to a lot of doctor appointments. If, however, you find that you frequently need specialists that are not in the network, or certain diagnostic tests that the MA plan won’t cover, an HMO may not be the right fit for you. Medicare Advantage plans generally require referrals to specialists, and prior authorizations before tests and procedures can be done; both can slow down the time between identification of a problem and diagnosis and treatment. Medicare Advantage plans will have co-pays at each doctor visit, we’ve seen copays as high as $50-60 dollars per visit, and some plans have deductibles as high as $5,000 before they make any payments.
If all this sounds like Greek to you, don’t despair! Every state has people specially trained on the “ins and outs” of all these options, and its free to meet with them and get some advice based on your own situation. Don’t believe everything you see on TV ads and flyers in your mailbox that you are being bombarded with this time of year. For reliable, factual information, contact the North Carolina Senior’s Health Insurance Information Program (SHIIP) at: https://www.ncdoi.gov/consumers/medicare-and-seniors-health-insurance-information-program-shiip. Here in Mecklenburg County (Greater Charlotte area), the Parks and Recreation Department has SHIIP counselors available. In other states, you can find your local SHIIP counselors through this link: https://www.shiptacenter.org/ .
The National Council on Aging has a helpful website at: https://www.mymedicarematters.org/enrollment/medicare-open-enrollment/?SID=5da764dc8d5aa297.
And finally, Medicare has an excellent website at https://www.medicare.gov. You can create an account, get your EOBs, evaluate plans and more.
Don’t put it off, get your annual insurance checkup so you’ll be ready for the plans that work best for you in January 2020!