Many people don't seriously evaluate their healthcare needs and Medicare options when they first become eligible, and even fewer review their needs before re-enrolling each year
Belleville, Ill. (Vocus) September 2, 2009
If you’re one of the more than 45 million people relying on Medicare for healthcare coverage, you may be paying for a plan that doesn’t meet your needs or is too expensive, according to Allsup, a nationwide provider of Social Security disability representation and Medicare services. But you’re in luck — Medicare annual enrollment starts Nov. 15 and ends Dec. 31, allowing anyone with Medicare to assess if they have the right plan.
“Many people don’t seriously evaluate their healthcare needs and Medicare options when they first become eligible, and even fewer review their needs before re-enrolling each year,” said Paul Gada, personal financial planning director and product manager for Allsup Medicare Advisor®. Allsup Medicare Advisor is a Medicare plan selection service that helps people understand and choose the most affordable and appropriate Medicare plan for their healthcare needs. (Allsup is not a Medicare plan provider.)
Gada added that many people don’t understand they have a wide variety of choices when it comes to Medicare coverage.
Allsup recommends people answer these questions before the enrollment deadline:
1. What will work best for me: traditional Medicare or Medicare Advantage?
If you visit the doctor often and take prescription drugs, a Medicare Advantage plan (Part C) may best fit your needs. If you only require routine medical visits and few prescriptions, traditional Medicare (Parts A and B) with a prescription drug plan (Part D) may work best. There are many factors to consider when answering this question, and your response may change over time.
2. Do I need a supplemental plan?
Medicare supplemental insurance can help pay costs not covered under traditional Medicare (Parts A and B). However, not everyone needs this type of policy, especially if they: are eligible for Medicaid or the Qualified Medicare Beneficiary program, have group health insurance through an employer, the government or the military, or already enrolled in a Medicare Advantage plan.
3. What if I have private healthcare coverage – should I use Medicare instead?
If you have coverage through a former or current employer, speak to the plan administrator before making changes. Consider comparing your private plan to your Medicare options, especially if your private plan is limited or the cost has increased significantly.
4. Can I see the same doctors that I do now?
The majority of healthcare providers (doctors, hospitals, physical therapists, etc.) accept traditional Medicare. While Medicare Advantage plans are available in almost every area of the United States, that doesn’t mean all doctors participate. Before you join any Medicare plan, determine if your doctor accepts that plan.
5. Does the plan cover prescription drugs?
Traditional Medicare doesn’t generally cover medications unless they’re administered in the doctor’s office or hospital. You have to purchase a Part D plan for the coverage. Medicare Advantage plans, however, can offer prescription drug coverage. If you choose traditional Medicare, you’ll need to enroll in a stand-alone Part D plan, possibly with additional cost to cover prescription costs.
6. Are my drugs covered?
Each prescription drug plan has a formulary – or list of drugs that it covers. Plans can change which drugs they cover, so you need to review this list each year.
7. Are my prescriptions expensive enough that I could fall into the Medicare donut hole?
Medicare Advantage plans with prescription drug coverage and stand-alone Part D plans may have a coverage gap, referred to as a donut hole. Once you and your plan have paid a certain amount for your prescriptions, you’ll have to pay the full cost, up to $3,453.75 in 2009. Only after this out-of-pocket amount is paid does Medicare begin to pay for your prescription costs again.
8. How much will I have to pay?
Traditional Medicare may be inexpensive, but it comes with high deductibles. Medicare Advantage plans may have similar or higher monthly premiums than traditional Medicare, but offer a zero-dollar deductible and low co-pays (e.g., $20 doctor visit co-pays). Some plans also cap total out-of-pocket costs.
9. Will the plan cover additional services, such as dental and vision care?
Some Medicare Advantage plans cover dental, vision and health and wellness programs not available through traditional Medicare.
10. Will I be covered while traveling?
Traditional Medicare provides coverage throughout the country. Some Medicare Advantage plans restrict coverage to certain areas, but many offer out-of-network coverage if you have an emergency while traveling. If you travel often or live in another area for part of the year, find a Medicare Advantage plan providing coverage in those areas.
Reviewing your needs every year, especially with the experienced help of an independent Medicare plan selection service like Allsup Medicare Advisor, before annual enrollment is crucial to ensure coverage, Gada said.
“There are probably dozens of Medicare Advantage and supplemental plans in your local area, providing a wide range of options,” he said. “Medicare is like any other type of insurance; you don’t want to be under-insured. But you also don’t want to pay for things you don’t need.”
Allsup is a nationwide provider of Social Security disability, Medicare and workers’ compensation services for individuals, employers and insurance carriers. Celebrating its 25th anniversary in 2009, Allsup employs about 600 professionals who deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. The company is based in Belleville, Ill., near St. Louis.
For more information, visit http://www.Allsup.com .
The information provided is not intended as a substitute for legal or other professional services. Legal or other expert assistance should be sought before making any decision that may affect your situation.
# # #