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Choose your Medicare plan wisely

As we enter the Open Enrollment time for Medicare recipients (Oct. 15 to Dec. 7, 2019) I encourage everyone currently or soon-to-be covered by Medicare to make informed decisions about plan selection. I know the options can be over-whelming, even to me who has worked in healthcare since 1974.

Traditional Medicare has existed since 1966, and includes Part A, which covers hospitalizations, and Part B, which covers physicians and out-patient services, usually at 80 percent coverage. Medicare added Medicare Advantage Plans (originally Medicare+Choice) in 1997, making several big changes to the program in 2003. Medicare Advantage Plans (sometimes referred to as Medicare Replacement Plans) are Part C. Add to that mix of alphabet soup, Medicare Plan D went into effect 2006, to provide coverage of prescription drugs for Medicare participants. Adding to the confusion, some Advantage Plans (Part C) include coverage of prescription drugs, so Plan D is not always necessary for those enrollees. Anyone who chooses Medicare A and B are able to purchase Medicare Gap insurance, a separate policy that covers some of what Medicare does not cover, including the 20 percent co-pay.

Each Medicare recipient needs to look at their individual situation and choose what is best for their financial situation and health needs. Be aware that changes to your health can occur suddenly and you cannot depend solely on your past experience to predict your future. Anyone who has had a sudden fall understands a broken bone can occur without warning! The only time you can make changes to your plan selection are during open enrollment or, if you are covered by a Medicare Advantage Plan, you can make some changes Jan. 1 to March 31, 2020.

Because of situations I have encountered, as well as stories I have heard from those working in rehabilitation and skilled nursing facilities, here are some things I encourage you to consider when making your choice. Remember, the least costly plan is only the best plan for you if you never need it!

Ask if you have the option to choose your doctor, including specialists, or if you must use those in the plan’s network.

Ask what your co-pay would be for a stay in a rehabilitation facility or skilled nursing facility, and whether you are covered from day one or if you have to have to be a hospital inpatient for three days first.

Ask if you have to use a specific hospital or long-term care facility in the plan’s network or if you can select the facility.

Ask if home care services are covered and what your co-pay would be for those services. Also, ask what area agencies are currently enrolled in the network.

Ask what your co-pay would be for in-network and out-of-network services.

Ask if there is an annual maximum out-of-pocket cost for in-network and out-of-network charges.

If you travel frequently, including wintering in the south, ask if you are covered in other states.

Because of the volume of details to consider when making your plan selection, I encourage you to consider talking with a SHIP counselor (State Health Insurance Assistance Program) to review the best option for you. SHIP counselors are specially trained, impartial, and equally important, their service is free. The counselors’ calendars fill quickly during open enrollment so don’t delay making your appointment.

SHIP counselors are available at Marion/Grant County Senior Center, 503 South Gallatin St., Marion, IN. (Disclosure – I am a member of the Board of Directors of the Marion/Grant County Senior Center.) Call the M/GC Senior Center at 765-662-6772 to schedule an appointment

If you live in Wabash County, SHIP counselors are available at the Winchester Senior Center/Living Well in Wabash County, 239 Bond Street, Wabash, IN 260-563-4475.

I hope this information helps you as you read the literature you are getting daily in your mailbox and on the television screen. Remember, the devil is in the details, so read the fine print on mailers and advertisements. The use of the word “may” can cover a multitude of options that may not fit your situation. I have experienced how overwhelming evaluating the many options can be, and it can sometimes reach the point you want to just point and click and have it over. Don’t do that! Read, research, get help, and choose carefully what you will live with for 2020.


Ruth Ann Masiongale, RN, MS, CSA