‘Tis the Season!

No, not the holiday season. It’s Medicare Season!

Open enrollment started on October 15 and will run through December 7. What exactly does “Open Enrollment” mean? It means that if you are eligible for Medicare (generally that’s if you are over the age of 65, or under the age of 65 and on Disability) you can enroll for a brand new Medicare plan or you can make any changes you want to your existing Medicare plan.

If you are already enrolled in Medicare and are happy with your plan, you don’t have to do anything. But for anyone who wants to make changes, the open enrollment period gives you incredible flexibility. For instance, suppose you pick a Medicare plan this week that you think will cover your needs. You do some more research next week and find out there is another plan that might work better for you. You can enroll in the second plan and it will automatically cancel the first one you selected. You can do this as many times as you like until the enrollment period ends on December 7.

But how do you sort through all of the details of the different plans? You can start with registering for one of our free Medicare Workshops or call to set a complimentary one-on-one consultation at our office. We can show you how these plan options apply to you.

Before meeting with us to enroll, think about your current medical needs and concerns. No Medicare representative will ever ask you specifically to list any ailments you might have. But it’s important to have in mind the frequency of your visits to the doctor’s office, the number of prescriptions you take, any specialized treatments you might need, and whether you wear glasses or hearing aids. Again, you will never be asked to mention any of these. But these factors can contribute to which plan might work best for you. And if you feel the need to point out anything specific to your enrollment representative, you can certainly volunteer it.

Common plan options:

Medicare Part B plans (for anything outside of hospitalization) usually fall into one of three categories: Advantage plans with a Preferred Provider Organization (PPO), Advantage plans with a Health Maintenance Organization (HMO), or Supplemental Insurance. The difference between these three primarily is seen in cost and the guidelines you have to work with. The plan you choose should be one that is affordable to you, but also practical for your medical needs.

PPO is the least common plan people choose from Medicare. It allows you to choose where you would like to receive care and who you want as your primary doctor. There are fewer restrictions on referrals to specialists. The other side of the coin though is that this type of plan takes significantly more out-of-pocket. Not only do you pay a monthly premium, but you also have co-pay and sometimes co-insurance fees.

Most individuals select either an HMO Advantage plan or Supplemental Insurance. What’s the difference here?

HMO is the most popular plan. The best feature of this plan is that you likely won’t have a monthly premium to pay. It includes a federally required drug plan and usually includes vision care (such as eye glasses) and dental. However HMO plans require a co-pay for anything that is not preventative care. That means yearly checkups are free, but bronchitis isn’t. Usually you will have an annual cap for that year. For example, suppose you were to enroll in a plan that has a $4500 cap. If you already paid that much in co-pay by next October, then your care from October to December of that year would have a $0 co-pay. Then the cap would start over at the beginning of the next year.

The limitation of an HMO is that you are required to select a primary only from the network you choose (such as Sharp or Scripps, locally). Then you are limited to medical care at facilities that are part of your assigned sub-network. Meaning that if you do have Sharp Medical Group, you can’t go to just any Sharp care facility. You need to check the list of your particular plan to choose a health center that is covered by that plan. For many in the San Diego area, that is not a matter of concern because we have a large variety of excellent doctors to choose from, no matter which plan you choose.

Supplemental is a private insurance that works with your Medicare plan. The supplemental side is not paid for by Medicare, but rather, by your monthly premium. There is usually no co-pay for this type of plan. Supplemental plans do not automatically include drug, vision, or dental. These will have to be added on. However, supplemental plans are not restricted to networks like HMO. You get more control over where you want your care for a monthly premium.

Here’s a super-simplified breakdown of the two:

Health Management Organization- limited to your plan’s sub-network with a co-pay and possibly no monthly premium

Supplemental Insurance- go anywhere, do anything with a monthly premium and possibly no co-pay

Please keep listening to our radio show for more Medicare information, register for one of our workshops that we’re hosting during open enrollment, or call us to set up an individualized appointment for more details on how you can get the most out of your Medicare plan!

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