Medicare’s Annual Open Enrollment period begins soon. During this time Medicare beneficiaries make important choices that affect their medical costs, the doctors they see and prescription coverage. There is a lot of information about open enrollment out there, yet for many older adults the process can be challenging.
Dr. White, an Internal Medicine specialist and Interim Chief Medical Officer with OptumCare Colorado Springs, provides useful tips and information to help older adults and their caregivers navigate open enrollment. Dr. White has been a part of the medical community in Southern Colorado for nearly 25 years serving as a rural physician in the San Luis Valley of south central Colorado and Colorado Springs.
Q: How do I get Medicare coverage?
A: There are several ways to get Medicare coverage. You can choose Original Medicare (Parts A and B). Part A is hospital coverage and Part B is medical coverage. Coverage is provided by the federal government.
You can also get benefits through a Medicare Advantage plan (called Part C). Medicare Advantage plans combine Part A and Part B coverage. Many plans also include prescription drug coverage (Part D) and offer additional benefits not provided by Original Medicare. Plans are offered by private insurance companies approved by Medicare.
There’s also what’s known as Medicare supplement plans. These plans help cover some of what Medicare Parts A and B don’t pay, such as portions of coinsurance, copayments and deductibles.
Q: What are some of the things I should think about when choosing coverage?
A: Ask yourself these questions to guide your decisions:
- How often do you visit the doctor?
- What prescription medications do you regularly take?
- Do you have a particular doctor, hospital or pharmacy that you want to use?
- Do you have retirement health coverage?
- Would you rather pay less in monthly premiums or pay less out of pocket when you receive health care?
Q: What is the best way to get information to make smart decisions during open enrollment?
A: Before you consider your enrollment options, make sure that the care provider network that you choose includes the doctors you prefer to see. If you like your doctors, confirm that they will be in the care provider network for the health plan you choose. Don’t assume that your doctors will stay in the same network each year.
You can Visit the Center for Medicare & Medicaid Services website at www.medicare.gov; call 1-800-MEDICARE, 24 hours a day, seven days a week; or contact Medicare Advantage health plans directly. You can also find helpful information at www.MedicareMadeClear.com.
Another good resource is an independent licensed insurance agent or health plan sales agent. These professionals help Medicare beneficiaries learn about their benefit options, what's going to fit their needs and how they can continue to see the doctors they prefer. They can be especially helpful in explaining health plans that have programs for chronic conditions or cover alternative medicine. Agents typically get paid a commission to sell you a policy, although they offer plans from a number of health plans.
Q: Why is the topic of health care planning so stressful?
A: Health care is a concern for everyone, and people want to make the right decisions that work best for their needs. It can be stressful for caretakers – people who make these decisions for their friends or family members – because they don’t want to make a decision or recommendation that will hurt the Medicare beneficiary financially or otherwise.
Ultimately, the worst response is no decision, where people say, “Well, I won't make a choice, I'll leave everything as-is because I'm comfortable with that.” The more you know and the sooner you know it, you can do your homework, do your research and then make a decision.
Don’t wait until the last minute. Start early and give yourself the time you need to make the decisions that will be right for you.
For more information about how to choose a health plan in Colorado Springs, call 1-866-964-1547.