On Oct. 15, Medicare opens its annual enrollment period. That period ends on Dec. 7. During this time, anyone eligible for Medicare can sign up for an Advantage plan as well as a prescription drug plan. For those enrolling in Medicare for the first time, the process can seem a little daunting and it can be easy to just go with what you see advertised. But it’s important to look past the postcards and cold calls to find a plan that fits you.
When choosing a Medicare plan the three biggest areas of focus for enrollees to consider are cost, if they can still see their doctors, and whether their medications are covered. This year the prescription component will require an extra level of attention.
“This year, more than any other, there is an incredible amount of stress on insurance companies to provide affordable and expansive drug formulations,” Brian Friedman, president of Nest Insurance Solutions in Cleveland, said. “There are probably more changes in that area this year than in any other year, but there are less coverage options in Northeast Ohio.”
Ivy Kopit of IvyK Insurance said that many people use this time of life to meet their travel ambitions so it is also important to consider how portable a Medicare plan is.
“Many people are still travelling and they want to be sure they are covered while outside their state,” Kopit said. “For example, the majority of Advantage plans only offer emergency and urgent care services when leaving the state where someone is enrolled. There are Advantage plans that have other travel benefits but it is important to understand the benefits for each plan.”
Enrollees often want to maximize the perks a plan has.
“Most Advantage plans have a no cost gym or fitness facility membership included in their plan,” Kopit explained. “Many enrollees may also be looking for transportation to and from doctor appointments and other essential needs. Some plans offer transportation and some do not.“
Some people also want their plans to help with other medical needs like over the counter drugs.
“Over the counter benefits are common amongst most Advantage plans,” Kopit said. “This is an allotted amount of funds that are put on a card that the enrollee can use to purchase over the counter wellness products from specific retailers. The amount of money varies with the carrier and is usually put on the card quarterly.”
Friedman said that other needs that people have are dental and vision which are “embedded in Advantage plans.”
But those options are not one-size-fits-all and some research will be needed to match those offerings with the enrollee’s health needs.
“In regard to dental, understanding if they are going to pay at the office visit and be reimbursed or if the office will submit their claims,” Kopit said Also, understanding if the plan will cover dentists out of the network. For vision, you’ll need to look at what is covered, the entire set of glasses or only the lenses or only the frames and if this benefit is yearly or every other year?“
Friedman also suggested that people explore what plans offer in the way of durable medical equipment which would cover wheelchairs, CPAP machines, rollators and other devices.
“Different plans provide different levels of comfort,” Friedman said.
While there are a number of online resources to use and friends, family members and neighbors to discuss plan options, working with Medicare specialists can offer enrollees experienced insight into the nuances each plan offers.
Noell Wolfgram Evans is a freelance journalist.