Medicare is a government health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). To be eligible for Medicare, one must be a legal permanent resident for the past five years or a U.S. citizen 65 years or older, or younger with a qualifying disability.
There many different “parts” of Medicare insurance: Part A, Part B, Part C, Part D, Part F and Part G. Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) together make up Original Medicare. Medicare Part C, also known as Medicare Advantage, and Medicare Part D (prescription drug coverage) programs allow you to get Medicare plans through private insurance companies that contract with Medicare. Medicare Supplement insurance (also called Medigap) is also available and sold by private companies, often referred to as Plan F or G.
Choosing a plan is an important and personal decision. Now is the time to think about what matters to you, and find the Medicare plan that meets your needs. Open enrollment runs from October 15th to December 7th. This is the time of year when Medicare participants can decide to stay with the plan they are currently on or change to a new plan. Regardless if you have been happy with your current plan, it is always better to review the plans every year, since they are constantly changing and upgrading what each plan covers.
In addition to cost, coverage, and benefits, here are some points you may want to consider as you compare Medicare options during Open Enrollment:
Doctor and hospital choice
You want to be comfortable with the people you are working with, especially when it comes to something as important as your health. Will your doctors and hospitals accept your current coverage next year? If you are thinking about changing plans, make sure you check which doctors and hospitals you will be able to use. Where are they located, and what are their hours?
Pharmacy access
Is the pharmacy you use included in your drug plan’s network? Remember that plan networks can change from year to year. If it is important to you to stay with the same pharmacy, it is worth checking to make sure they will still be in your plan’s network.
Travel
Maybe you travel a lot, or spend part of the year in a different state. If you do, make sure you know whether your coverage will travel with you.
One important aspect to Open Enrollment is your Medicare Part D plan. The Medicare Part D program provides prescription drug coverage. You can sign up for a stand-alone Medicare Part D Prescription Drug Plan to work alongside your Original Medicare coverage, or you can get all your Medicare coverage through a Medicare Advantage Plan.
If you enroll in a stand-alone Medicare Prescription Drug Plan (or a Medicare Advantage Plan), make sure you choose a plan that covers your medications. Every Medicare Part D Plan has a formulary that lists the drugs it covers, and many plans make their formularies available online. A plan’s formulary may change at any time. You will receive notice from your plan when necessary.
Most beneficiaries have to pay a premium for Medicare Part D, along with other costs such as copayments and coinsurance; these costs vary among plans. Although this insurance is optional, if you do not enroll when you are first eligible for Medicare, you could face a late enrollment penalty if you decide you want this coverage later on.
By logging onto www.medicare.gov and clicking the FIND DRUG AND HEALTH PLANS on the main page, you are able to compare all plans based off of your prescriptions, pharmacy and location. This will tell you which plan is the most affordable and what the star ratings are for that plan.
Decatur County Memorial Hospital (DCMH) is working hard to make sure you have choices in the way you get the Medicare benefits you have earned. At DCMH, Pharmacist Matt Weber is helping patients who are having difficulty choosing the correct plan that is right for them. He has already met with approximately 40 patients and on average, he is saving each person between 400 and 500 dollars per year on their prescriptions. He was able to save one individual $4,000 a year!
“Open Enrollment can be a very confusing process to patients, especially when they do not have much experience with insurance or they are unaware of how Medicare works. It is important for all Medicare patients to know and understand all of their options.”
If you have any questions or would like to speak with Matt about your Medicare Part D plan, please call the DCMH Pharmacy at 812-663-1250 or visit www.medicare.gov for more information.
“You want to have a Pharmacy and a Pharmacist you can trust. I am happy to assist anyone with the Open Enrollment process. I want to help people save money and live a happier life knowing they are covered.”