By: Mei Kameda, Program Coordinator, Healthy Living
Medicare is a federal health insurance program for people who are 65 years or older, certain younger populations with disabilities and people with certain medical conditions such as End-Stage Renal Disease (ESRD). Last week, we talked about a general overview of Medicare. As stated last week, Medicare has an Open Enrollment Period from October 15th – December 7th, which is very important for those who would like to change their Medicare health plans and prescription drug coverage for the following year to a plan that is better suit their needs.
The real question is – how do I pick the right plan for me?
To answer that question, it’s really case by case since we all have different medical conditions and needs. However, here are some things to consider when choosing or changing your Medicare plan coverage:1
- Coverage – Ask yourself, “How well does the plan cover the services that I will need based on my health condition(s)?”
- Other Coverage – If you have other health or prescription drug coverage, make sure that you understand HOW that works with Medicare. For example, if you are still receiving coverage through your employer, it is best to talk to your employer’s benefit counselor before you make any changes.
- Costs– Ask yourself, “How much am I paying for my premiums? Deductibles? Other costs? How much am I paying for services such as hospital stays or doctor’s visits? Do I have a yearly out of pocket maximum for medical services?” It is important to understand the coverage rules that may affect the amount you pay.
- Choice of Doctors and Hospitals – Ask yourself, “Does my doctor accept this coverage? Do my other doctors and specialists accept this plan? Are they accepting new patients? Am I able to be covered if I want to pick a certain hospital to stay at? Do I have to choose hospitals and my providers from a network? Do I need to get referrals?”
- Prescription Drugs – Ask yourself, “Do I need to join a Medicare Prescription Drug Plan? Am I taking any medications? Do I have enough prescription drug coverage right now with my current plan? If I join a prescription drug plan later, will I need to pay a penalty? What is the star rating for my plan?* Are my drugs covered under the plan that I pick? Am I eligible for the Medication Therapy Management Program (MTM)?**”
- Quality of Care – Ask yourself, “Am I satisfied with the care that I am receiving right now? How are other people rating the Medicare plan, providers, drug plans, and services?” (Compare plans and providers here)
- Convenience – Ask yourself, “Is my plan convenient for me? Where are my doctors’ offices located? What are the hours of operation? Which pharmacies can I use? Can I get prescriptions by mail or do I need to pick them up? Does my healthcare provider use electronic health records? Will I be able to get a copy of my health records? Which pharmacies can I use? Is there a preferred cost sharing? “ Try to figure out if your plan is convenient for YOU based on your situation.
- Travel – Ask yourself, “If I go traveling, will my plan cover if I travel out of state or outside of the United States?”
Ultimately, it is difficult to say, “This plan is for you,” since many of our health conditions vary – for some people, Plan Red may be well suited, whereas for another individual, Plan Orange may be beneficial. (note: Plan Red and Plan Orange are hypothetical plan names) Therefore, asking the questions listed above will give you an overall idea to help you narrow down your selection of plans. I hope that you find these tips helpful in making any changes during Open Enrollment if needed!
Where do I find Medicare plan information and comparison tools?
Call 1-800-MEDICARE or go to www.medicare.gov
New to Medicare? Check out the 2016 Medicare & You booklet here!
In partnership with the Council on Aging Orange County, Keiro staff members, Dianne Kujubu Belli and Kanako Fukuyama are certified HICAP (Health Insurance Counseling & Advocacy Program) counselors. They provide free Medicare and related counseling at Anaheim Free Methodist Church, Orange Coast Free Methodist Church, Orange County Buddhist Church, and Wintersburg Presbyterian Church. Please contact Dianne at 213.873.5702 or email@example.com and Kanako at 213.873.5709 or firstname.lastname@example.org for questions or to make an appointment. Counseling is available in both English and Japanese.
*The Medicare Star Rating System was created to measure how well Medicare Advantage and Prescription Drug Plan (Part D) plans are performing. Medicare rates each plan based on how well the plan did in categories such as quality of care and customer service. It also has a section where individuals may review and provide input on how the plan performed. Ratings range from 1 to 5 stars, with 5 being the highest and 1 being the lowest. Each year, Medicare reviews and releases the new star ratings in the fall.2
** The Medication Therapy Management Program (MTM) offers FREE services to eligible members of the Medicare drug plan. This program helps make sure that the medications are working properly to improve your health. You can talk with a pharmacist or other healthcare professionals and find out how to get the most benefit from the medication you are taking. You can ask questions about costs, drug reactions, and other problems that you may encounter. Please contact your drug plan to see if you are eligible.3
About the Author:
Mei Kameda is the Program Coordinator for the Kawana Center for Healthy Living at Keiro. She graduated from California State University, Long Beach with a Bachelor of Science degree in Community Health Science (option in Community Health Education) and a minor in Communication Studies. In her spare time, Mei enjoys going on runs, baking, and volunteering which are a few of the many activities that allow her to live her life on purpose.
The material presented on this site is for informational purposes only and does not necessarily represent the opinions of Keiro, or its contributors. Readers should consult appropriate health, legal, or financial professionals on any matter relating to their health and well-being. Full disclaimer