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2-25-2023 12:02am
Medicare Q & A with Gloria Paradiso, VP of Blue Cross Blue Shield of Massachusetts
Darlene Cancell
Editor
Medicare's Open Enrollment Period is ongoing through March 31, 2023, and in anticipation of questions that consumers may have in selecting a health care plan, Westwood Minute is publishing the following information in Question and Answer format, with answers attributed to Gloria Paradiso, vice president of Blue Cross Blue Shield of Massachusetts.
Thanks to Gloria Paradiso and Blue Cross Blue Shield of Massachusetts for contributing this news to Westwood Minute.
Q: Who are Medicare plans for?
A: Medicare plans are available for people 65 and older, and for select individuals with disabilities or specific medical conditions. There are generally two groups of seniors shopping for a plan: those who already have Medicare and may be shopping within their current carrier or across carriers, and those who are aging into Medicare and going through the initial enrollment period, which begins three months before and ends three months after an individual’s 65th birthday.
What’s most important for each Medicare shopper in Massachusetts is that there is no one-size-fits-all plan, so each person should look for information from trusted sources so they can better understand their options and the process for enrolling.
Q: Why is now an important time to know about Medicare plans?
A: From January 1-March 31, the Open Enrollment Period allows Medicare Advantage or Prescription Drug Plan members to make a one-time plan change if they are unhappy with their current plan. There is also a chance to enroll in Medicare Parts A and/or B for those who missed their first opportunity during the Initial Enrollment Period.
The start of a new year is also often when individuals assess their overall health and wellness, including plan benefits, to ensure they have the best plan for their unique needs. This is particularly important for those 65 and older, which includes nearly one-fifth of Westwood’s population. With a growing sector working beyond age 65, delaying retirement, and deferring Social Security benefits, the Medicare landscape can be challenging to navigate, especially with several new Medicare health plans entering the market in Massachusetts.
Q: What does Medicare typically cover?
A: The program is not intended to cover all health care services at no cost, but rather to provide a set of basic medical and inpatient needs and about 80% of outpatient care.
There are two primary ways that eligible individuals get Medicare coverage – through Original Medicare, which is offered by the federal government and covers Medicare Parts A and B, or through complimentary Medicare plans, like Medicare Advantage or Medicare Supplement plans, which are offered by private health plans such as Blue Cross. Medicare Advantage plans include Parts A and B, and many include Part D, which helps cover the cost of prescription drugs, plus a lot of supplemental benefits, such as dental, vision and hearing coverage. Medicare Supplement plans include all of the same benefits as Original Medicare and, with a small monthly premium, help cover the gaps that Original Medicare doesn't cover, like copayments, co-insurance and deductibles.
Q: What is new this year with Medicare plans?
A: Last year’s Inflation Reduction Act (IRA) includes some key changes to Medicare. One important change beginning in 2023 is a cap on insulin costs of $35 per month, including for Massachusetts residents. About one-third of Medicare beneficiaries in the U.S. are diabetic, so this is extremely important for so many individuals who have struggled with the rising cost of insulin.
Q: What is the best piece of advice for individuals who are facing Medicare decisions?
A: Medicare is complicated, so we encourage consumers to understand the basics before they start to shop. They can access helpful information at Medicare.gov, by connecting with counselors at The SHINE Program, or through their local senior center. When people understand their plan options, they can make informed choices, for themselves or for their loved ones. If individuals seeking Medicare find a plan that meets their health and wellness needs and that they can afford, they will be more likely to take advantage of their benefits and stay healthy in the long run.
