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Photo by Centre for Ageing Better from Unsplash.
Thanks to Blue Cross Blue Shield of Massachusetts for contributing information for this article.
The annual enrollment period for Medicare plans starts in October, and for folks aged 65 years old and older, this summer is a great time to start thinking about your individual health needs and what plan may work best for you.
Commonly Asked Questions and Answers to Medicare
Q: Who are Medicare plans for?
A: Medicare provides health insurance to anyone 65 and older, and to select individuals with disabilities or specific medical conditions. It is a health program that helps ensure that this group of Americans is able to meet hospital, medical, and health costs in an affordable way.
If you are a senior shopping for a Medicare plan, you are likely in one of two groups. The first group is comprised of those who already have Medicare and may be shopping within their current plan provider or across providers. The second group are those who are aging into Medicare. The individuals in this group will have an initial enrollment period that begins three months before their 65th birthday, and which ends three months after that birthday.
Q: Do you have to enroll in Medicare?
While you are not required to enroll in Medicare, it’s important to understand your options at the time of eligibility. After years of paying into Medicare, it can be a big milestone when you finally qualify to sign up.
Late enrollment penalties may apply if you choose not to enroll when initially eligible or enroll at a later date. However, you might qualify to delay your insurance if you work for a company or organization that employs 20 or more people.
Q: Why is now an important time to know about Medicare plans?
Individuals who are currently enrolled in Medicare will be able to switch to a new plan during the annual enrollment period (October 15-December 7 each year), so the spring and summer are an optimal time of year to learn about the basics of Medicare. When Medicare-eligible individuals understand the complexities of the enrollment process, they can make an informed decision about enrolling in Medicare or switch plans in the fall.
You can use this summer to obtain an overall assessment of your health and wellness. Review the benefits that are included in your current health plan and determine if they are adequate for you. This review will help you ensure that you can identify the best health plan for your unique needs.
Q: What does Medicare typically cover?
A: Rather than providing a blanket of free health care coverage, the program helps provide for basic medical and inpatient needs and about 80% of outpatient care, making overall health care costs more affordable.
There are two primary ways that eligible individuals get Medicare coverage – through Original Medicare or through Medicare plans.
Original Medicare is health care managed by the federal government. It includes Medicare Parts A and B. Part A hospital insurance covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care. Part B coverage includes doctor and other health care providers' services and outpatient care. Part B also covers durable medical equipment, home health care, and some preventive services. Individuals may choose to add Part D coverage, which adds coverage for prescription drugs.
Medicare plans, like Medicare Advantage or Medicare Supplement plans, are offered by private health plans. 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 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.
According to the Centers for Medicare and Medicaid Services, one in three Medicare beneficiaries in the U.S. are diabetic and more than 3.3 million beneficiaries use insulin, so this change is an important one for many individuals who have struggled with the rising cost of insulin.
Understand the Basics to Make the Best Decision
Medicare is complicated, so seniors should try 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. Researching Medicare Plan providers can also be helpful.
When people understand their plan options, they can make informed choices, for themselves or for their loved ones. If individuals find a Medicare 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.
