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5 important things to know about Medicare

Created date

September 25th, 2012

Once a year, you have the opportunity to change your health insurance options through Medicare. This year, that time period is from October 15 through December 7. When making these important decisions, you not only have to consider your physical health but also your financial health. Keep in mind these important tips before you sign on the dotted line.

1. Make sure your health insurance meets your needs.

Just like you have a physical checkup each year, you should have a health insurance checkup, says Penny Folden, vice president of sales and service for Erickson Advantage, a Medicare Advantage plan exclusively for residents of Erickson Living communities. Your health may change every year and so might your coverage. The cost could increase but some services may no longer be covered. Your doctor can be a good resource for you, and your Annual Wellness Visit (now covered by Medicare) is a good place to start. The Annual Wellness Visit is a valuable preventive benefit, says Austin Welsh, M.D., medical director at
#mce_temp_url#, an Erickson Living community in Overland Park, Kans. It can give you some idea of what you are facing with regard to your health for instance, what kind of diagnostic tests you may need during the year, or whether you ll need to see a certain specialist.

2. Medicare doesn t cover everything.

Medicare Part A covers the inpatient costs of hospitals, skilled nursing facilities, hospice, and some other costs. For many people, there is no premium for Part A because they paid Medicare taxes while working. Other people may have to pay a premium. Medicare Part B, which has a premium, covers physicians fees, outpatient services, medical equipment, home health, and some preventive services. Many health costs fall outside of this coverage, however, so you need to supplement with a Medigap supplemental plan or change to a Medicare Advantage plan. You need to consider several factors when making this decision, including how much out-of-pocket expense you can handle, Folden says. Medigap plans may offer more flexibility when it comes to your choice of providers, but they tend to be more expensive than Medicare Advantage plans. Some Medicare Advantage plans (also called Medicare Part C) are designed for people with certain medical conditions, including diabetes and chronic heart failure. These plans may cover more essential benefits to keep you in your best health. Other Medicare Advantage plans may cover additional costs such as transportation or dental care; because these plans are prevention focused, they may offer more wellness benefits. Medicare Part D is the drug plan, and not all medications are covered. There are many factors to consider when choosing Part D, including which drugs you take, your dosage amounts, and which pharmacies you use.

3. Your premium is not your final cost.

Low premiums for any part of Medicare may mean high co-pays or more coinsurance costs, Folden explains. In exchange for a low premium, you may end up paying a $50 co-pay every time you see your regular doctor. Look at your past year s bills to see what kind of services you needed and how often you needed them before you decide on a premium level. Your doctor can help you figure out what preventive services you may need and may also be able to adjust your medications to better fit your Part D plan, Welsh says.

4. Compare, compare, compare.

The Medicare website ( helps you learn about the four parts of Medicare. You can compare Medigap policies, Medicare Advantage Plans, and Part D plans. You can find out what plans are available in your area, coverage summaries, and cost estimates. For Medicare Advantage plans, there is a rating system from one to five stars, Folden says. Some of the areas that are rated are customer service, management of chronic conditions, and preventive services. Look carefully at your options. A plan may cover your primary care doctor but not your local hospital. Some people may want to look beyond Medicare to other sources of health insurance, Folden advises. You may have lower costs and good coverage through veteran s benefits, for example.

5. Don t be overwhelmed.

Don t get so bogged down that you get frustrated and make the wrong choices just to get the whole process over with. There are many resources to help. is a good place to start as is the Medicare and You brochure that you should receive in the mail. Staff at your state s health insurance assistance program (SHIP) may be able to walk you through the process. A health insurance agent that you trust is another option, Folden says. They tend to be quite savvy about the whole system and your specific needs. If you make a mistake, remember that you can change anything and everything about your coverage during the next open enrollment period.