What you need to know to get the best coverage


Published/Last Modified on Wednesday, December 9, 2009 3:57 PM MST


Understanding healthcare coverage can be overwhelming. And keeping up with changes in Medicare benefits is no different. For many people, that translates into doing nothing about updating their current coverage.


But experts say it isn't wise to blindly re-enroll in existing Medicare plans. Medicare and its private sector plans typically make annual changes to:

√ Medical benefits

√ Prescription benefits

√ Coverage limits

√ Consumer premiums

√ Out-of-pocket expenses

So current users and new enrollees need to take the time to review plan options in order to get the best coverage possible.

• Make sure you know current enrollment dates.

• For 2009, the window is November 15 through December 31. Those eligible for Medicare can review and - if necessary - adjust their Medicare coverage, which consists of traditional Medicare or private sector plan options licensed to operate in Medicare; Medicare Advantage and Medicare Part D.

• If you do not choose new coverage, you will be automatically re-enrolled in the same coverage you had.

To help you evaluate your options, Chris Hakim, the Director of eHealthMedicare.com, encourages people to answer these questions.

Does my coverage match my changing healthcare needs?

"If you're managing a chronic condition, like diabetes, heart disease or cancer," says Hakim, "make sure your coverage keeps pace with your needs for new or existing medications. You also want to be sure you can continue to see your primary care physician or specialist." Hakim also recommends that if you're having elective surgery in the coming year, make sure it's covered in your existing plan or your coverage.

Will I have my same doctor?

Check with your primary care physician, specialists and your private plan to make sure you can continue to see your doctors. Medicare's contracted networks of doctors and hospitals are subject to change, so find out if your doctor will be in the plan. "If you elect traditional Medicare, which allows you to see any doctor or visit any hospital that accepts Medicare," says Hakim, "it's still a good idea to confirm your doctors are participating in Medicare."

Will my premiums and deductibles increase?

Traditional Medicare (Parts A & B), private sector plans in the Medicare Advantage program (Part C), and the Prescription Drug (Part D) program are likely to have changes in 2010. They may result in either savings or additional cost to consumers based on the coverage you select. Make sure you understand how these changes impact you.

Medicare Part D provides coverage for name-brand and generic prescriptions. Review your current medications with your doctor and ask about potential medication changes for next year. Then, review Part D coverage to make sure it covers what you need.

Get Knowledgeable Advice

There are many resources available to you, including these:

√ Medicare: www.medicare.gov; 800-MEDICARE

√ The National Council on Aging: www.ncoa.org

√ The Medicare Rights Center: www.medicarerights.org

Hakim also encourages people to try www.eHealthMedicare.com, a Web site with information about traditional Medicare and private Medicare options.

"At eHealthMedicare.com we're offering comprehensive Medicare information, in easy-to-navigate Web pages and straightforward language," says Hakim. "We also provide access to quality Medicare carriers and phone support with trained professionals."

The difference between picking a plan that's right for you and one that isn't could be thousands of dollars per year. Take the time now to study your choices so you can get the coverage you need next year.

 

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