Medicare for 2017: 8 Important Facts You Should Consider

Written by: Tracy B. McManamon

Medicare for 2017: 8 Important Facts You Should Consider: for those who are already enrolled in Medicare Plans, open enrollment season is later this fall. With it comes many individuals who are looking to shop for plans that better fit their needs or simply want better benefits. When looking to change your coverage, here are 8 important things that you should consider:

1)        Coverage: How well does your current Medicare Plan cover the services that you need now or may need in the future?

2)        Additional Coverage: If you have additional coverage such as prescription drug coverage or other health plans, it’s important to make sure that you understand how it works with your Medicare plan. If your other coverage is from a Tribal Health or Indian Program or is employment-related, discuss your benefits with your benefits administrator or insurer before you change your benefits.

3)        Costs: How much do you currently pay for health services such as doctor visits or hospital stays? What do you pay for deductibles, premiums or other costs? Make sure you understand all the rules of your plan and how it affects your costs.  Can you get billed for excess charges?

4)        Hospital and Doctor Choice: Do you have to choose your health care providers and hospitals from a specific network? Will your doctor accept your coverage and plan? Do you need to get referrals to specialists or to hospitals?

5)        Prescription Drug Coverage: Do you need to purchase a Medicare Prescription Drug Plan? Do you have what is known as creditable prescription drug coverage? If you choose to join a drug plan later, will you pay a penalty? Will the costs of your prescription drugs under the separate plans? Are your prescriptions covered under the plans formulary? Do any of the coverage rules apply to your prescriptions?

6)        Care Quality: The care quality can vary by plan, are you satisfied with your current Medicare care? How have Medicare Plans and others on Medicare rated your current drug and health plans?

7)        Convenience: Which pharmacies will you have access to? Where are the doctor’s offices and the hours that they are available? Can you get electronic copies of your information? Is the pharmacy you use in the plan’s network? Do the doctors use EHRs (electronic health records)?  If your pharmacy is in network, is it preferred?

8)        Travel: Will the Medicare plan provide coverage for you if you travel out of state or country?

If you are already enrolled in a Medicare plan, review the Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) that is sent to you each year. The ANOC provides you with information including costs, any changes in coverage or the service area effective starting the first of the year. The EOC gives you details about what your specific plan covers and how much you pay. If you do not receive either of these, contact your plan.

Last tip:  If you are still confused, just give me a call.  I have been helping folks navigate and understand Medicare for over 29 years.  I offer free consultations.  I can be personally reached at 877-549-1212

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