By Carol A. Cates, MSN, MBA, RN
Chief Nursing Officer
Odessa Regional Medical Center
Autumn is my favorite season of the year. I love the weather, with the temps cooling down but not cold, the way the leaves on the trees in my yard change from green to gold or red. I love that I again start wearing my sweaters and boots, but not have to wear a coat.
Even the food in the fall just makes me happy, eating things like soups and stews or being able to bake without having to worry about overheating the house. I love looking forward to and planning for the holidays and all the get-togethers with family and friends. But there is one thing about Autumn that just drives me nuts: all the commercials from older celebrities pushing “advantage plans” during Medicare annual enrollment, which started Saturday.
At my hospital, and I am sure in every hospital across the nation, nearly every day we must tell someone that the Medicare program they signed up for does not cover the services that person wants/needs on discharge from the hospital. That is true for both traditional Medicare and for Medicare Advantage plans (also known as part C). When that happens, that person and their family must make the difficult decision to pay for services out of pocket, which can be extremely expensive, or to do without those services completely. Neither option is really a good option, unfortunately.
Because of the issues I see so often with people not knowing their coverage under Medicare, I cannot stress enough how important it is that you look at the program you have signed up for if you are of Medicare age, and make sure to read the fine print and make sure it meets your needs now, and into the next year. Remember to consider things related to unexpected health conditions like falls with injury or strokes and the ability for your family to care for you as you recover. Do your research, don’t depend on recommendations from people who are paid to advocate for a particular program.
Here are several questions to consider as you do your research.
1) Are you happy with your current plan? If your plan is working well, you don’t need to change. But, if you had problems, now is the time to make a change in the plan you have so that you don’t have the same problems moving forward.
2) Can you get the same or better coverage for less cost? A wealth management expert recommends you look not only at the monthly premiums but also calculate how much you have spent on co-pays and deductibles. You might be able to get a similar plan that better fits your financial needs if you shop around.
3) Do you want Medigap coverage? When you enroll in Medicare part B, you have six months to a Medigap plan with no questions asked. If you have switched to Medicare Advantage, and make the change back, Medigap coverage is limited to that first 12 months after you changed to Medicare Advantage. Those “fine print” rules can be really confusing. Because of that, it’s important to make sure you know you can get the coverage you want before you make a change.
4) Do you plan to travel outside your local area in the next year? Traditional Medicare coverage is good anywhere in the US if the provider accepts Medicare. However, some of the Medicare Advantage plans are limited to specific geographic areas. If you travel, make sure you have the coverage you need regardless of the plan you choose.
5) Did you get a new diagnosis in the last year? Make sure your current provider and any potential providers cover that condition. Case managers that help patients manage chronic conditions like diabetes or high blood pressure are also good features to look for in a new plan.
6) Do you need dental or vision coverage? Original Medicare doesn’t cover dental, vision, hearing aids or fitness programs. Some Medicare Advantage plans do. Again, look for the coverage that best fits your needs.
7) Do you need prescription drug coverage and are your medications covered? With traditional Medicare, you will need to add plan D for prescription coverage. Some Medicare Advantage plans cover medications, others do not. Regardless, make sure that the plan you chose covers your medications if you need a prescription drug plan.
8) Do you need help finding the right plan? There are agents who do help people find the right Medicare coverage. Experts recommend going to someone who understands Medicare and represents more than one plan so you can get direction on a plan that will best fit your needs rather than the agent’s product.
Finally, it might be simpler to sign up for automatic re-enrollment, but it is wise to take the time each year to make sure that your plan is continuing to meet your needs. Things can change a great deal in a year when it comes to health.
