Understanding the basics of Medicare requires research

By ​​Jim Pittman, Director of Medicare Advantage Communications - Ochsner Health Plan, and Liz Miller, Communication Manager - GetSetUp

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The Medicare Advantage annual enrollment period starts October 15 and goes until December 7 for coverage next year. During the annual enrollment period, those eligible for Medicare, who are 65+ or meet one of the other requirements such as a disability, have an opportunity to sign up for the plan of their choice that best meets their needs. Those who wish to switch their Medicare Advantage plans can also do so at this time.

It is important that each person take time before each annual enrollment period to research the plans offered in their services area and select the one that best meets their unique health and wellness needs. 

* If this is your first time eligible, pay careful attention to Medicare Part B so you avoid penalty fees.

The different parts of Medicare

 Medicare can be broken into a number of different parts. 

Original Medicare (Part A & B) you are often directly enrolled in this once you start receiving your Social Security benefits. However, it is important to assure that you are accurately enrolled in a plan that best fits your needs.

• Medicare Part A helps pay for inpatient care in a hospital and after a hospital stay, it covers some time in a skilled nursing facility. It also pays for some home health care and hospice care.

• Medicare Part B helps pay for health care services like doctor’s visits, outpatient care, home health care, durable medical equipment, and some preventive services.

Then there are a variety of other Medicare services that are run by private insurance companies but follow Medicare rules. 

• Supplemental Policies including Medigap help to pay Medicare out-of-pocket co-pay costs, co-insurance, and deductible expenses.

• Medicare Advantage Plans include all the benefits and services covered under Part A and Part B of Original Medicare plus includes prescription drugs and a rich variety of additional benefits such as vision, hearing, dental, and fitness -- all in one plan. These plans have specific regional networks and defined service areas but offer tremendous value.

• Medicare Part D helps cover the cost of prescription drugs.

So why would anyone not go for an all-in-one plan like Medicare Advantage?

Not all Medicare plans are the same and each one depends on your own personal circumstances. Most people get Part A of Medicare free if they have paid Medicare taxes long enough. Though most people still pay a monthly premium for Part B. 

Jim Pittman the Director of Medicare Advantage Communications - Ochsner Health Plan has worked in the health and managed care industries for over 30 years and sheds some insight on these concepts. 

“For many adults age 65-plus coming off of employee, individual, or small group health plans, a Medicare Advantage plan will provide some of the richest healthcare benefits that they have ever experienced - for no little or no additional cost, small or no copayments, and often zero deductibles,” said Jim.  “However, Medicare Advantage plans are often regional, with defined service areas and specific contracted healthcare providers. So, there are a number of different factors to consider when choosing a plan. Each person eligible for Medicare Advantage should research and compare the plans offered in their area and carefully choose the one that works best for their individual needs and  lifestyle.”

How to research the right Medicare plan for you

The go-to site for research is Medicare.gov where you can read in-depth about each plan in your area and compare them side-by-side. All you have to do is put in your zip code and then find and compare the plans that are available where you live. 

“Sometimes Medicare Advantage plans might offer richer benefit plans in one area and not in others. While the total out-of-pocket cost might be little or nothing every month, it’s important to enroll in a plan that includes your physician, a strong provider network, and best meets your specific healthcare needs,” said Jim.

One of the biggest differences can come in some of the added or supplemental benefits offered by each Medicare Advantage plan. This includes benefits like preventative care, fitness, and wellness benefits.

“Frankly, I’m looking forward to turning 65 because you can’t beat the price and overall coverage of Medicare Advantage. It’s offered at little or no monthly cost and in addition to prescription drugs most Medicare Advantage plans cover hearing, vision, dental, and often offer fitness benefits. While you might be limited to using only the providers who are contracted with the plan, the benefits and money savings often far outweigh any limitations -- especially when compared to original Medicare and overall cost of the commercial group and individual health plans,” said Jim.

Most people look first to see if their doctor is included in the Medicare Advantage plan of their preference, according to Jim. While this isn’t a bad strategy, if that’s the only factor it can reduce a person’s opportunity to have access to local health clubs or other rich preventative health and wellness benefits. 

“Medicare Advantage plans do a great job at working in partnership with contracted healthcare providers to support members when they are sick and help to keep members well by providing supplemental benefits that provide wonderful preventative health and wellness features,”  said Jim. 

As people retire many people move to a new area and aren’t sure what plan to select since they don’t have a lot of information on their new location. Research can help with that.

Steps to prepare to find the best Medicare Advantage plan in your new location

1. Research plans at your new zip code.
2.  If you have friends or neighbors in the area ask them about their plans, providers, and doctors to gain insight into the region.
3. Remember you can change plans if you see better resources and up to 30 days into your new plan.

Key Medicare plan research

According to Jim, there are 5 main areas you want to pay attention to when researching for the Medicare option that best fits your needs.

1. Network of Doctors - Research healthcare providers in that market and look at their reputation. Research the institutions they use to see if they have new tech and focus on preventative health.
2. Prescription Drug Coverage - Most people by 65 are likely taking some medication and this can only increase as we age. Make sure medication is covered on your plan so you don’t get hit with high prescription costs.
3. Research Providers and Hospitals - Make sure quality clinics and hospitals are near where you live and won’t require extensive travel to reach one in your network. 
4. Vision, Hearing, and Dental - Our eyes, ears, and teeth tend to weaken as we age so make sure you have access to benefits that help you get the support you need to keep seeing, hearing, and eating with pleasure.
5. Supplemental Benefits - Medicare doesn’t have to be only about helping you when you are sick.  Compare benefits annually. Make sure your plan offers preventative health benefits like fitness centers, learning opportunities, or meal services plans.

Now that you know where to go to research and how. Why not get started?