Medicare Open Enrollment Starts Today: What Doctors Say You Should Know
Medicare’s annual enrollment period (AEP) begins today (Oct. 15) and ends on Dec. 7. That gives you some time to switch from Original Medicare to Medicare Advantage or vice versa, or change your Part D drug plan. But as a recent survey from eHealth shows, most Medicare beneficiaries have gaps in knowledge about Medicare that could result in higher out-of-pocket costs or even compromise their care. Nifty 50+ talked to Dr. Heather Swanson, regional medical officer at CareMore Health, a coordinated healthcare network that provides services in Arizona, California, Nevada and Tennessee, about what doctors want you to know before you lock in your coverage for next year.
Anticipating the Care You’ll Need in Advance Will Help You Select a Plan
Consider scheduling an appointment with your primary physician to talk about the types of medical care and prescriptions you might need in the coming year. That’s especially important if you have a chronic condition.
“If you have conditions such as heart disease, diabetes, COPD, arthritis or cancer, your physician can estimate how often you may need to see specialists,” Dr. Swanson said. They can also suggest what you might need in terms of:
- Diagnostic tests
- Procedures or surgeries
- Prescription medications
- Preventative services
- Therapy or supportive services
Using coordinated care for your medical services makes it easier for your primary care doctor to estimate your upcoming needs. Coordinated care “brings a patient’s healthcare providers, medications, treatments and support services together under a more connected approach,” Dr. Swanson said.
Your Spouse’s 2027 Retirement Might Affect Your Coverage
If you’ve had Medicare and also have been covered under your spouse’s workplace insurance, you’ll no longer have secondary coverage once they leave their current plan.
“Don’t wait until that coverage ends to evaluate your options.” Dr. Swanson warned. Take time to understand exactly what benefits you’re losing and what Medicare will cover on its own.
Dr. Swanson also recommends considering whether or not a Medigap supplemental policy or Advantage plan makes sense for you. Medigap offsets Original Medicare deductibles, coinsurance and copayments. An Advantage plan can provide extra benefits, such as vision, hearing and dental, and it usually includes prescription drugs. But coverage might be capped, and you can’t use Medigap to cover out-of-pocket costs.
The Cheapest Plan Doesn’t Always Save You Money
A plan with low premiums or perks isn’t a good value if it costs more out of pocket in the long run. While acknowledging that many people have no choice but to consider monthly costs, Dr. Swanson recommends giving top priority to the provider network and Plan D prescription drug coverage if at all possible.
Keep the following in mind when thinking about the network:
- Is your primary care physician in-network?
- Are specialists included?
- Are preferred hospitals and health systems covered?
- Will I need referrals?
- What if I need care while traveling?
- Are case management or coordinated care services available?
When it comes to prescription drugs, “a medication that is affordable under one plan could become substantially more expensive under another,” Dr. Swanson said. Whether it’s listed as preferred or non-preferred, which price tier it’s on and whether you pay coinsurance or copays can significantly impact your costs.
Help Is Available If You Need It
Navigating Medicare rules and plan choices can be overwhelming, but you don’t have to figure it out on your own. CareMore frequently encourages patients struggling with the decision to take advantage of unbiased Medicare counseling resources.
“A counselor can help explain coverage options, while the physician can help the patient anticipate the services, treatments and medications they are likely to need in the coming year,” Dr. Swanson said. “Together, that information helps patients make more informed decisions.”
