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Examine your insurance options every year

Created date

October 22nd, 2013
Examine your insurance options every year

If you’ve had Medicare as your primary insurance for a number of years, you may not examine it too closely. Every year, however, Medicare (and all insurances for that matter) modify coverage rules, take away some benefits, and add others. “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 coverage might change. Costs could go up but some services may no longer be paid for.”

Personalizing your plan

The open enrollment period (October 15-December 7) gives you time to examine your policies while keeping in mind what to expect health-wise the coming year. One way to do this is to take advantage of the Annual Wellness Visit—a recent benefit offered by Medicare.

“This visit is an opportunity for you and your provider to discuss a number of important health concerns including your cognitive functioning, mood, hearing, gait, and how well you are doing with everyday activities,” says Sangeetha Shan-Bala, M.D., staff physician at Greenspring, an Erickson Living community in Springfield, Va. “It is not the same as a physical examination—you still need one of those every year.”

Having an Annual Wellness Visit can give you some idea of what your health goals should be. “We can use the information obtained from the Annual Wellness Visit and your physical exam to personalize your plan of care for the coming year,” Shan-Bala says. “We can also decide which preventive services you need.”

Be savvy about cost

Choosing low premiums is not always a smart move. “For any part of Medicare, low premiums could mean you pay higher co-pays or coinsurance,” Folden explains.

Charges for inpatient hospitals, skilled nursing facilities, and hospice are covered by Medicare Part A. If you paid Medicare taxes when you were employed, you might not have a Part A premium. Medicare Part B, however, which covers services that are medically necessary to diagnose or treat a health condition (and also preventive services) has a premium associated with it. Along with that premium, you may have co-pays that go along with services such as doctors’ fees, medical equipment, home health, laboratory tests, and other outpatient services.

Some services are not covered in full, so to fill in the blanks, many people choose Medigap policies or Medicare Advantage (also called Medicare Part C) plans. “When deciding between Medigap or Medicare Advantage plans, consider how much you can afford to pay out of pocket,” Folden advises. “Medicare Advantage plans tend to be less expensive than Medigap policies.”

Overall, Medicare Advantage plans have a focus on wellness, so more preventive services may be covered. Some Medicare Advantage plans are specifically for people with certain chronic health conditions such as diabetes and heart failure, so additional benefits may be available to help people manage the disease. In some instances, Medicare Advantage plans offer dental care and transportation benefits.

Medicare Part D covers prescription drugs, and although it can save you some money, there are several costs that you may pay throughout the coverage year such as premiums, co-pays, and deductibles. Although there have been some changes to help close the coverage gap (donut hole), it still exists, so many people have to pay more once they’ve reached that limit. Medigap and Medicare Advantage plans can help with some out-of-pocket outlays.

Finding a quality plan

There are several ways to compare insurances. On the Medicare website ( you can compare benefits, estimate costs, and find what’s available in your community for Medigap, Medicare Advantage, and also Part D. “Ratings—one to five stars—are available for Medicare Advantage plans that evaluate chronic condition management, preventive services, and the quality of customer service,” Folden says.

A trustworthy insurance agent can help, and for assistance with the open enrollment process, state health insurance program representatives can guide you.