Preparing for Medicare Advantage Enrollment Season
By Kathy McVey
Forty three million Americans are on Medicare. And seven million people have Medicare Advantage plans (MA plans).
Medicare is government-regulated health insurance for people age 65 or older, those under age 65 with certain disabilities, and anyone with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant). If you pay into Social Security, you automatically receive Medicare upon turning 65.
Medicare Advantage plans are health plan options offered by private insurance companies and approved by Medicare. These plans often offer all the coverage of original Medicare and more, such as value-added benefits—vision, hearing, fitness and/or health and wellness programs. Many Medicare Advantage plans offer lower copayments and cover additional benefits and services not covered by original Medicare. Additionally, some plans include prescription drug coverage.
Knowing your MA plan helps you maximize your benefits.
November 15–December 31 each year is considered the Annual Enrollment Period. This is the time of year that seniors can elect to stay with their existing MA plan or enroll with another plan. There are certain situations in which you can join, switch or drop their MA plan at different times of the year. Savvy MA plan shoppers should always understand their situation. Once you’re enrolled, your coverage begins on January 1 of the following year. It’s vitally important that Medicare participants know the rules of participation. The MA Annual Enrollment Period is only a six week period to make a decision that will affect you the entire year.
So, how do you evaluate a MA plan? There are five key areas to consider.
First area to consider is the monthly premium. Many MA plans offer zero or low premiums, but remember premium isn’t everything. You want value for your dollar.
Second is the network of physicians and hospitals. Does the plan offer a strong network of providers? Are those doctors that you need in the health plan’s network?
Third is the cost for a physician visit or medical services. What will be your out-of-pocket expenses each month? Can you afford these costs?
Fourth is pharmacy coverage. If you are looking for a MA plan with this coverage, what drugs are covered that you currently take? Make sure you’re getting the coverage that you need.
And finally, the fifth area to consider is the wellness and preventive services programs that a MA plan offers. These value-added benefits can really add up. Does the plan offer immunizations, such as flu and pneumonia shots, annual physical exams, mammogram and prostate exams, discounts on health clubs and gyms, etc. These added benefits can truly be a deal breaker.
Ultimately, selecting a MA plan is a personal choice that should be made with careful consideration. To learn more, contact a reputable insurance agent or visit www.medicare.gov.
Kathy McVey is the manager of Medicare sales at Optima Health.
Source: Medicare & You, 2009, Centers for Medicaid & Medicare Services, www.medicare.gov