As the new year begins, it’s important to understand your Medicare coverage in order to avoid unexpected costs. Investing the time now will help you maximize your benefits and prevent the frustration that comes from unwanted financial surprises.
If you have a Medicare Advantage plan and you changed plans during the fall Annual Enrollment Period, it’s a good idea to review your new plan and make sure you understand your plan’s benefits and out of pocket costs. Even if you kept the same coverage as last year, there were probably some changes to your plan for this year. Your insurer would have notified you of these changes last fall by sending you an Annual Notice of Change (ANOC) letter. If you are unaware of what has changed, contact your insurance carrier and request a copy of your ANOC.
Here’s what you should know about your benefits in the new year:
Know Your Out of Pocket Costs
This includes your monthly premium, if you have one, and any deductibles, copays, coinsurances and out of pocket maximums for both medical services and prescriptions. Out of pocket costs vary by plan and change every year.
If you have a Medicare Advantage plan, one of the best ways to control your out of pocket costs is to see providers within your plan’s network. Networks vary by plan and insurance carrier, and providers can be added or dropped throughout the year. Make sure your current providers are in your plan’s network and check before seeing any new providers. If your plan offers out of network coverage, you can see providers outside the network, but it will cost you more. If you don’t have out of network coverage your insurer will not cover any services performed by out of network providers unless you have received prior approval.
Know Which Preventive Services and Screenings Medicare Covers
You can be proactive in managing your own healthcare by taking advantage of the many preventive services and screenings that are covered in full by Medicare. They are designed to help keep you healthy and provide early detection of serious diseases allowing for better treatment and outcomes. Preventive services include your annual wellness visit with your primary care doctor, as well as flu, pneumonia and Covid vaccines. Preventive screenings are covered for diseases such as diabetes, glaucoma, Hepatitis C, heart disease and cancers. Screenings for depression, alcohol misuse and sessions to help quit smoking are also covered.
Know Which Supplemental Benefits Are Covered
If you have a Medicare Advantage plan, your plan probably offers some additional health and wellness benefits. These benefits vary by plan and insurance carrier so it’s important to know what your plan covers so you don’t miss out on the extra benefits available to you. Many plans offer vision, dental and hearing coverage. You should understand which specific services are covered, what your out of pocket costs will be, and if there is a maximum annual cap on what your insurer will pay. There may be separate provider networks for these services so make sure you are using an in network provider if required.
Some plans offer gym memberships, chiropractic, massage or acupuncture benefits. You may also have benefits such as an over the counter allowance, transportation to medical visits, home delivered meals after a hospital stay, and more. By knowing what your plan offers you can make use of all the benefits available to you.
Know Where to Find Information About Your Benefits
It’s a good idea to familiarize yourself with your insurer’s website and all the information available to you there. If you set up an online account you will be able to access information 24/7 on your benefits, prescriptions, and claims. You will also have access to your insurer’s provider search tool and drug formulary.
Know Where to Get Help if You Can’t Afford Your Healthcare Costs
If you are struggling to afford your Medicare coverage in the new year, it’s important to know that assistance is available for those who qualify. These programs include:
- Medicare Savings Programs which help pay your monthly Part B premium and any Part A premium if you have one, and may also help cover deductibles, coinsurance, or copayments.
- Extra Help which helps pay for some or most of the costs of Medicare Part D prescription drug coverage.
- Your state’s Pharmacy Assistance Program which helps eligible individuals pay for prescriptions.
If you have questions about your benefits in this new year, the dedicated team at Healthcare Educators is here to help. Contact us today.