By Carol A. Cates, MSN, MBA, RN, NEA-BC
Chief Nursing Officer
Odessa Regional Medical Center
I’m travelling this week out of state. As I get ready each morning in my hotel room, I’ve been listening to the local news programming. As I’ve been listening, two groups of ads have really stuck out to me. The first is the sheer volume of political ads since I am visiting a “swing state.” We have quite a few in Odessa/Midland, but nothing like I have seen here. The other one, I do see at home, and that is the number of ads for Medicare Advantage. It’s Medicare Open Enrollment Season again, and with that comes the decision for many people on their Medicare plan choices. For lack of a better way to put it, when it comes to Medicare open enrollment, the old phrase, “Let the buyer beware” is a good philosophy.
Medicare Open Enrollment for coverage in 2025 started on October 15, 2024, and ends December 7, 2024. If you are age 65 or older, it’s important that you enroll for coverage during the open enrollment period. Just as important, is when you enroll, that you know exactly what you are getting from your coverage and that the coverage meets your individual needs. Not just now, but if you have a health care crisis which forces you to make major lifestyle changes, such as a fall resulting in a hip fracture, a heart attack, or a stroke. The best way to make that decision is to be informed about your options.
According to Medicare.gov there are two types of Medicare coverage plans: Original Medicare and Medicare Advantage Plans. Original Medicare has two parts, part A and part B. Part A covers Inpatient hospital care, skilled nursing facility care, nursing home care that is not custodial or long-term care, hospice care and home health care. Some things to consider with part A (hospital insurance) is that it may not cover an observation (sometimes called an “overnight” stay), and it covers 80% of costs and has a deductible, with no out-of-pocket limit. Part B (medical insurance) covers medically necessary services by health care providers, and preventative services. Some things to consider with part B is again the 80% and deductibles apply to medically necessary services, most preventative services are covered 100%. Medigap insurance, which can be furnished by enrolling privately, or is often a part of pension plans or other retirement benefits is a good way of covering the 20% and deductible costs associated with original Medicare. Those plans can also cover observation stays and other “gaps” in Original Medicare coverage.
A Medicare Advantage Plan (also known as part C) is a plan that combines parts A & B (and sometimes part D, which I will talk about it a bit) and is administered by a private insurer. They are the ones that are advertised in the ads on TV where an older celebrity talks about “free dental services, free rides to health care appointments” and similar benefits. Every Medicare Advantage Plan is different, and if you decide to look at Medicare Advantage Plans, make sure you know exactly what you are getting. Some are good at limiting the up-front costs that people experience from Original Medicare, but limit services like rehabilitation and skilled nursing care when someone has a catastrophic health event where they need more time to get back to baseline. Some are opposite, where the benefits for longer-term care are great, and the up-front benefits are less.
Medicare part D is an optional addition to Medicare which covers prescription drugs. Like most insurers, Medicare part D works with a formulary where some drugs are covered better than others. If you know of your specific medications, you can get a really good idea of costs and the advantages to traditional part D or a Medicare Advantage plan that includes drug coverage by looking at their formularies.
Whatever plan you chose, remember you can change it next year if needed, but generally, costs to the individual stay lowest when you enroll in one plan at age 65 and stick with it. Do your own research, don’t be swayed by a commercial or a company that has a vested interested in people picking specific plans. The Medicare website has a great unbiased tool in helping you find the best plan for you on their website: www.Medicare.gov. Your health is far too important to put your coverage to chance. Take the saying “let the buyer beware” and do your research so you find the plan that works best for you and your loved ones.
