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Medicare is a wonderful program that serves millions of people every day. This federal health insurance program was signed into law on July 30, 1965. According to The Centers for Medicare & Medicaid Services, the original program included hospital insurance (part A) and medical insurance (part B). Less than 10 years later, the eligibility expanded to include those who had end-stage kidney disease, the disabled, and those 65 years of age or older. Medicare Advantage Plans (part C) become options in 2003. In 2006, the prescription drug benefit (Part D) went into effect. In 2010, the Affordable Care Act helped coordinate Medicare to provide better quality services to those who are enrolled[1].
There are different ways to qualify for Medicare. If you are a U.S. citizen over the age of 65 who has worked and paid into the Medicare system for at least 10 years (or your spouse did), you are likely eligible for coverage. If you are below the age of 65, you are generally eligible if you got Social Security disability benefits for at least 24 months or have a qualifying disability or special condition[2].
Medicare serves almost 64 million people as of October 2021, and serves over 49 million with Part D coverage[3]. Each year, most of those individuals have the opportunity to make changes to their coverage during open enrollment, which runs from October 15 through December 7 of each year. Those who are enrolled in Medicare Advantage have open enrollment from January 1 through March 31, during which time they can change their plans or switch to original Medicare[4]. (Note that some places might call open enrollment the “Annual Election Period” or AEP.)
But how do you choose the Medicare plan that is right for you? Let’s look at the basics about shopping for Medicare.
How to Begin Looking for a Medicare Plan
When you sign up for Medicare or opt to change your plan, you will be presented with a range of choices. These might have varying premiums, copays, coinsurance, deductibles, out of pocket limits, and more. They will also have other differences. For instance, some will offer dental and vision insurance, the option to purchase items over the counter, or even help with transportation to doctor’s visits. Some will include telehealth and delivery of your prescription drugs at no extra charge to you. Though all provide basic preventative care and screenings, some have more robust offerings than others, so think about what screenings you might need for certain conditions[5].
It can be helpful to write down the differences on a piece of paper to compare them side by side. Look over the information and highlight what matters most to you, such as the option for dental coverage or the lowest premiums possible. Also ask yourself these questions:
· How do you feel about your current doctor? Do you want a different one?
· What specialists do you currently see? Are there any conditions that might require a specialist in the near future? Just as with your doctor, consider if you would like to keep your same specialists or if you want to choose different ones.
· Do you need coverage for dental and vision? And how much? For instance, if you need dental coverage, do you need something that simply covers cleanings and x-rays, or something that covers in-depth restorations or dentures?
· What’s your overall budget for medical and health care throughout the year? That might help you determine what your out of pocket limit should be.
By asking yourself in-depth questions about your needs and wants, you can narrow down your options and determine which plan is right for you. Imagine looking at medical alert devices. You would ask yourself very specific questions that relate to your situation, and those would determine what you need. For instance, if you like to go hiking, you might want a wrist watch style medical alarm with GPS and pedometer to ensure help can find you anywhere. If you are confined to your home and the nearby area, you could go with a home-based alert device with a base station. The idea is to look at what your individual needs are and what features are important to you and then plan accordingly when making your choice.
A Note About Common Acronyms
With Medicare Advantage, you’ll have even more plan options than with original Medicare, and some of those can be confusing. WebMD breaks down the three most common ones:
· HMOs: Health Maintenance Organizations have a limited network of providers and don’t cover those who are out of network (in most cases). The benefit is lower premiums.
· PPOs: Preferred Provider Organizations give you a wider range of physicians to choose from and a discount if you go with those who are in the PPO network. However, they will also generally pay a percentage for those who are out of the network, albeit with higher out of pocket costs for you.
· SNPs: Special Needs Plans cover those who have specific disabilities or other needs. These work much like an HMO in that you must choose physicians that are in your network; otherwise, they are likely not covered and you must pay for services out of pocket.
Tips on Finding the Right Medicare Options
When you decide to look into medical alert technology, you will likely review your options before choosing the device that’s best for you. But when it comes to choosing Medicare coverage, your choices aren’t nearly as clear-cut. There are many factors to consider, which is why it’s so important to follow these tips as you get started shopping:
· Compare potential plans. Did you know that only 30% of those with Medicare compared their current plan with new ones during the 2018 enrollment period? That’s according to a study by the Kaiser Family Foundation. Though it might seem like your current plan is exactly what you need, it’s possible that a plan can change from one year to the next, or you might find another plan that gives you even better benefits than what you have now. Not making comparisons could be a bigger financial burden than you think; about 90% of all those enrolled in the prescription drug coverage plan were overpaying for their medications, a problem that could be solved by comparing plans[6].
· Make sure your doctor still participates in your plan. If you have a wonderful doctor who takes great care of you, the last thing you want to do is have to find someone else. If you want to keep your current doctor, it’s a very good idea to look at whether they are still participating in your particular plan. If they are not, then all your costs to see them will come out of pocket, and that can add up fast. Make sure your local hospital and clinics participate in the plan as well.
· Pay attention to premiums and the bottom line. It can be very tempting to go with the lowest possible premium. However, it’s important to look at the total package. What are your copays, coinsurance, and deductibles? Does the plan with the lowest premium still cover your prescription drugs? What’s the out-of-pocket limit for a particular plan? Paying very low premiums might be great until something bad happens, and if you have a high out-of-pocket limit or deductible, you’ve just wound up paying much more than you would have if you went with a higher premium (and thus likely more comprehensive) plan.
· What about the STARS? The STAR rating system applies to Medicare Advantage and prescription drug plans. One star indicates lower quality, while five stars indicate the highest quality. Look for a rating of at least three to select better plan options for you.
· Read the notices. Plans are required to notify you of significant changes in the plan you currently have, such as a higher premium or a change in deductible. This is called an Annual Notice of Change[7]. They are also required to let you know if your doctor is out of your network halfway through the year. In that case, they are also required to help you find a new participating physician[8]. Pay attention to all notices that come from Medicare and remember that you will likely receive these as paper notices through the U.S. Mail.
Still need help? Reach out to the top source at Medicare.gov. There you’ll find a wealth of information, explanations, and details on everything from how Medicare works and who it covers to how to enroll in a plan. You can also get in touch via phone at 1-800-MEDICARE (1-800-633-4227) or through the Medicare.gov chat feature online. Those who use TTY should call 1-877-486-2048. And if you need a well-versed counselor to help you figure out your options, get in touch with your State Health Insurance Assistance Program.
While you are considering your healthcare, consider your safety and well-being as well. Medical alert systems with fall detection can keep you safer at home and on the go by giving you peace of mind that help is just a button push away, as well as providing you with a device that senses falls as they happen and can notify trained professionals immediately to assist you. Just as with Medicare, there several grea options to choose from!