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11-03-2022 12:40am
Open Enrollment Underway through December 7th for Choosing a Medicare Plan
Darlene Cancell
Editor
October 15th was the start of the open enrollment period for Medicare that runs through December 7, 2022. But do you know your choices?
It’s not a question that affects only patients. Often, medical decision-makers are the caregivers. But a recent survey of 1,500 American adults by SingleCare found that 34 percent of respondents were not familiar with Medicare at all, and 65 percent do not know what part(s) of Medicare they should enroll in.
Westwood Minute spoke with Eddie Walker, Vice President of Medicare Product at Blue Cross Blue Shield of Massachusetts (BCBSMA), to help clarify the options. BCBSMA is the not-for-profit health plan headquartered in Boston, that is funded by government payments and administrative fees. For every premium dollar that BCBSMA takes in, 90 cents go to health care services and medicines for its members.
Medicare in a Nutshell
The subject of Medicare and health insurance can be intimidating to those who are just now aging into eligibility. Medicare is the federally funded health insurance program for those aged 65 or older, some younger people with disabilities, and people with End-Stage-Renal Disease.
Medicare coverage for specific services is broken into Parts A, B, C, and D. Part A covers hospital, inpatient and hospice costs. Part B covers doctor visits and outpatient costs. Together, Part A and Part B are known as “Original Medicare.” Part C is called Medicare Advantage, coverage that includes Original Medicare plus supplemental coverage. Part D covers prescription drug costs.
How to Get Medicare Coverage
There are two ways to get Medicare coverage. The most popular way is through enrollment in Original Medicare, or coverage through the federal government. People who enroll in Original Medicare (Parts A & B) can also add Part D (prescription drug coverage) to their health plan.
The second way to get Medicare coverage is by enrolling in Part C – Medicare Advantage, which is offered by private companies approved by Medicare. Health plans such as BCBSMA offer enrollment in Part C - Medicare Advantage.
Mr. Walker notes that Medicare Advantage has become a popular choice among consumers because it not only includes the coverage of Original Medicare but also supplemental benefits such as dental, hearing tests and vision care. It can also cover prescription drugs. With the availability of zero premium plans, Part C can be affordable as well.
The Process of Selecting the Right Health Plan
In choosing Medicare coverage, “You need to understand the basics and what Parts A and B cover,” offers Mr. Walker. Because everyone is different and has a unique circumstance, Mr. Walker notes that, “There is no one-size-fits-all.”
He advises consumers to be mindful of their particular circumstances. “Ask yourself, how is my health, and do I have any conditions to be mindful of?"
Mr. Walker adds, "Second, make a list of any providers you see on a regular basis, because an important factor in selecting a plan is also fit and not just cost. Third, be mindful of any medication you take on a regular basis and make sure they are covered in the plan you are exploring and are not too costly. Lastly, is your budget and what you can afford,” he states.
Friends and family can be helpful resources. Open enrollment occurs during the holiday season, a perfect time for talking to friends and family to find out about their experiences with their own health plans. Ask them about how happy they are with their health plans, Mr. Walker suggests.
How the Inflation Adjustment Act Affects Medicare Plans and Choices
“The Inflation Adjustment Act has brought so many positive, good things, in my personal opinion, and is a welcome thing for the industry,” remarks Mr. Walker. “BCBSMA has focused on lowering the cost of prescription drugs.” One of the biggest struggles people have with affordability in their healthcare relates to the cost of medicines, he notes.
Under the Inflation Adjustment Act, the cost of insulin-controlling drugs will be capped at $35 per month for patients that use them. “There are lots of really great things for Medicare consumers and a lot of it is focused on saving you costs when it comes to lowering the costs of prescription drugs," comments Mr. Walker.
There are a number of additional features of the new legislation which Mr. Walker highlights. In 2023, drug companies must provide rebates if the cost of drugs rise faster than inflation, he says. Another key provision for 2023, according to Mr. Walker, is that adult vaccines, such as the shingles vaccine, will be covered by Part D. Additionally, Medicare will be expanding eligibility of low-income subsidy applicants, enabling a wider net of people to qualify. Lastly, the federal government will have the ability to negotiate prices for top-selling drugs, he says.
Thanks to Eddie Walker for contributing to this article and speaking with Westwood Minute.
Updated 11/03/2022 at 12:47 p.m. A correction has been made to a typographical error.
