Medicare plans can change coverage, providers, co-pays and benefits each year. Even if one is happy with one’s present Medicare and prescription drug plans, it is important to review the plans during the Open Enrollment Period from Oct. 15 to Dec. 7; something might change that could affect your coverage, benefits and/or costs next year.
If the present plans are still good for next year, you need do nothing and will remain on the plans. If not, you can change to a more suitable plan during the OEP.
Medicare Advantage Plans (Part C) offer lower costs and additional benefits. The plan steps between Medicare and the beneficiary; Medicare pays the plan a fixed amount for each beneficiary. The plan makes money by keeping its beneficiaries healthy.
However, except in emergencies, plan members must use providers – doctors, hospitals and services – that are affiliated with the plan. Hence the importance of verifying that your doctors and hospitals are affiliated with the plan.
If you go to a provider outside the plan, except in an emergency or with prior plan authorization, neither Medicare nor the plan will cover the cost.
Medicare Supplement Plans, also known as Medigap Plans, generally pay the costs that Medicare approves but doesn’t pay, such as doctor and hospital co-pays.
Medigap plans have a monthly premium, are significantly more expensive than Advantage plans, but allow you to use any doctor, hospital or service that accepts Medicare, anywhere.
You can do all this using the Plan Finder at Medicare.gov. However, checking all this can be daunting for most people.
In addition to the assistance resources listed in the commentary, New Mexico residents can get assistance by phone from counselors at the New Mexico Aging & Disability Resource Center. The phone number is 1-800-432-2080, option 2.
Those living in or near Santa Fe can, if they prefer, make an appointment to meet with a counselor for in-person assistance at the Resource Center.
In addition, ADRC counselors will hold enrollment events around the state during the Open Enrollment Period. For a list of dates, times and locations, go to the ADRC web site, http://ift.tt/2ebmABU, click on “Special Events”, then click on “List of enrollment dates”.
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