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Be Smart with Your Medicare Options

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If you are already on Medicare—or will be soon—it’s important that you carefully review the various options available to you under the program. It’s not as simple as you may think. If you let cost be your only determining factor, for example, you may find that you are limiting your choice of services available, including some of the best specialists and hospitals in the country. Each fall (this year from October 15 to December 7), Medicare runs an “Open Enrollment” period. Beneficiaries have the option to…

Do nothing and keep their current Medicare medical and drug coverage.

Switch to a Medicare Advantage plan (programs run by private companies approved by Medicare, which are similar to HMOs in that they have a preset roster of doctors and hospitals you must use or pay more out-of-pocket for your care). When to consider: If you want to save money. One-third of Medicare-eligible beneficiaries choose one of these plans for that reason.

• Switch from a Medicare Advantage plan to traditional Medicare (which allows you to see any doctor or hospital in the country that accepts Medicare). When to consider: If you live part of the year in another state…or you don’t want to be restricted to an Advantage plan’s limitations via their network.

• Change Medicare Advantage plans. When to consider: The selection of doctors or hospitals doesn’t include ones you want to use. To find out what plans are available, call Medicare at 800-633-4227…or go to Medicare.gov.

• Change Medigap plans (insurance that supplements the traditional Medicare program). When to consider: If you’re looking for a less expensive plan…or want to switch to a more comprehensive plan. Note: If you are in an Advantage plan, you do not need—and cannot buy—Medigap coverage. Also, based on your health, you can be turned down or charged more by an insurer other than your current Medigap plan.

• Change Part D prescription drug plans…sign up for a drug plan (if you don’t have one now)…or drop drug coverage. When to consider: If the drug formulary changes or does not include one or more of your medications.

To ensure that you make the smartest choice for your situation…

Don’t be cheap! Choosing a less expensive plan may cost you more in the long run—and limit your access to quality care. A friend of mine enrolled in a Medicare Advantage plan that cost him no additional premium than that taken each month out of his Social Security check. He thought he was relatively healthy, so why pay more? In the next year, he had four unexpected surgeries and more than 40 doctor office visits. Between the hospital co-pays and all the doctor visits, his out-of-pocket costs exceeded $7,000. Had he selected the original Medicare program and a maximum-coverage Medigap plan, the same scenario would have cost him $3,500 for the premium and less than $500 in co-pays.

Get access to the best care. Research shows that health insurance plans that offer low premiums and limited networks of hospitals and doctors are more likely to exclude doctors affiliated with National Cancer Institute (NCI)–Designated Cancer Centers (widely considered the best places for cancer care). In other words, low premium costs may limit your access to excellent care—even if it’s available in your own community!

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Source: Charles B. Inlander, a consumer advocate and health-care consultant based in Fogelsville, Pennsylvania. He was the founding president of the nonprofit People’s Medical Society, a consumer advocacy organization credited with key improvements in the quality of US health care, and is the author or coauthor of more than 20 consumer-health books. Date: October 1, 2017
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