Medicare: Choosing the Right Plan Improves Your Health and So Does Your Life
Did you know Medicare (the U.S.’s federal health insurance for people 65 and over) is one the most popular federal programs in the U.S.? But not everyone who has it — some 25% according to surveys — fully understands it. The key to Medicare happiness depends on how much effort you put into learning about it. Peter Orona, a licensed insurance agent and owner of ABCD Medicare, compares Medicare to getting a drivers license.
“No one told you how to drive,” Orona explained, “but you took it upon yourself to take the test and get your license. This is no different. It’s your responsibility to understand the rules of the game and educate yourself appropriately as a consumer.”
To get the most out of Medicare, the first thing you want to do is make sure you’re on the right plan. The plan you chose affects how much you pay for coverage, what medical services you receive, the kind of doctors you use and the quality of care you get. If you’re not already enrolled in Medicare, take a moment to read our last article[link] for information about who qualifies, how to enroll and what plans Medicare has available.
One of the most important things to remember about Medicare is that you always have options. During the yearly Annual Enrollment Period, which is happening right now (October 15 to December 7), you get to make changes in your coverage that will take effect in the beginning of the next year.
This is big. It means you can change to a Medicare Advantage Plan, or change back to original Medicare. Or you can switch to another Medicare Advantage Plan because maybe you don’t like your doctor or another plan will cover a maintenance prescription that your current plan doesn’t. Or you can do nothing and the plan you currently have will renew automatically for another year.
All these options, while good, can cause confusion. And if you watch TV, commercials from health insurance companies may leave you more confused than ever. If that happens, help is available. An independent broker can help you cut through the confusion.
“As a broker,” Orona explained, “we work for our clients by focusing on plans that fit their needs and lifestyles. We listen to our clients and offer solutions by filtering to plans that help maximize their benefits and ultimately help improve their health and lives and lifestyles.
“We do all the work in searching providers and doctors in network, prescription formularies, pharmacies and hospitals,” Orona added. “We also determine if they qualify for extra benefits such as Extra Help, Medicaid/AHCCCS and chronic care management. It does not cost you anything to ask for help from an agent/broker. The plan you choose pays the agent for helping you.”
Where to Start
When choosing a plan, Orona suggested a list of things to consider.
“There’s always low-hanging fruit that stands out a bit,” Orona said. “Some of it may be the maximum out-of-pocket, which is the most someone pays in a Medicare Advantage plan. There’s hospital stays — what’s the cost to stay in the hospital? The doctors, pharmacies and hospitals in network are important. Those are the easy things to look at.”
The more difficult part is comparing the list of medicines that health plans cover. Orona said the number-one thing people complain about is the cost of prescriptions. Each plan can have different prescription lists (called a formulary), and some generic drugs cost more on some plans than others. That’s why having a relationship with an agent is important.
“I get calls, ‘Hey I’ve been diagnosed with this’ or ‘I have that’,” Orona explained. “Then we’ll dig a little further and see what we can do to help. We’re not allowed to, nor should we, give medical advice to anybody. We just let them know if their prescription is going to be covered.”
The Advantage of Medicare Advantage
Every year Medicare Advantage Plans can improve or withdraw benefits they offer. The insurance carriers will send out an Annual Notice of Change to let you know what’s changing. Since insurance carriers, especially in Arizona, are becoming more competitive, it’s worth exploring the benefits they offer. These days it’s not just dental and bonus payments for checkups.
“There are a lot of offerings that are coming,” Orona said, “especially for people with chronic conditions. So if you have a stroke or cancer, that’s not chronic but you have additional benefits to support you.”
To learn more about Medicare ins and outs, visit this month’s Cafecito Time con Equality Health with moderator Maria Rebozo LaPine and special guest Peter Orona.