All Medicare recipients, and most people enrolled in health plans through their employers or the Affordable Care Act, have the opportunity to sign up and/or change plans during the annual Open Enrollment Period. For Medicare, this is Oct 15 through December 7, 2023.
While I am sure you have many things you would rather do than review your health insurance options, PLEASE set aside time for this critically important task.
Why is it important? Once you choose a plan, you are generally locked in for a year. If you find in March that you have a condition you want treated by “Dr. X,” but Dr. X is not in your health plan, you are out of luck. The fall open enrollment period is your chance to ensure that your needs are best met in 2024.
In the early days of Medicare, there was very little choice and life was much simpler. Now you have the major option of “classic” Medicare or Medicare Advantage (MA). In addition, if you opt for classic Medicare, there are options for the “fill-in” plans that cover Medicare’s deductibles.
This year, for the first time, over half of Medicare enrollees are in MA plans. These plans, run by commercial health insurance companies and heavily marketed, offer benefits not covered by traditional Medicare, such as payment towards hearing aids and eyeglasses, and even gym memberships. Their major downside is limited choice of doctors and hospitals. There have also been allegations that some plans have denied or delayed needed care. There is no free lunch, and plans that lure you in with lower out-of-pocket costs (and are run by profit-making companies) need to cut costs somewhere.
1.Even if you are happy with your current MA plan, read the plan information carefully to see what has changed. Plans can and do change what they cover each year. Be sure you know what medications will be covered if your plan provides drug coverage, and what your medicines will cost you. Check if any doctors you are seeing will no longer be covered. Ditto a hospital you prefer to use.
2.Double check with your doctors’ offices to be sure what plans they will be accepting. MA information is often out of date with their list of participating doctors.
3.Be sure your plan and your health needs are a good fit. A plan that covers your fitness club membership may have been inviting when you felt healthy but may no longer be the best fit if you have a new serious illness and the best doctors and hospitals for this condition are “out of network.”
4.Take the time to look at alternatives. Since both plans and your health needs change, there may be a plan that is a better fit. Check the plan ratings on medicare.gov.
5.Ignore the hype and read the fine print. You will be barraged with advertising and sales pitches. Regard these with the same skepticism as you would any other advertising.
Finally, maintain good health habits. Do not smoke or drink; exercise and eat a health plant-focused diet. The healthier you are, the less you will need to worry about what services your plan covers
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