Speaking of coverage, that’s the second item in Medicare’s list. Of course, you want to tailor your Medicare plan to meet your healthcare needs, so understanding what your plan covers is important. And this is true not only the first time you sign up, but annually when you have the option to change coverage.
It would be nice if you could just choose your plan once and only make changes when your circumstances change. The problem is that many facets of the choices you made last year can be changed, often significantly, when the new enrollment period comes around. Part D (prescription drug) plans are notorious for adjusting the “formulary” quite often. (Formulary is the glossary term for the list of drugs covered by the plan.) Plus, your own health may change, requiring a new prescription that wasn’t covered under your old plan’s formulary.
The next item in the list is your other coverage. Primarily this deals with Medigap coverage and any coverage that you have from other sources, such as an employer’s coverage. The point is that it’s important to know how this extra coverage coordinates with your Medicare plan, so that you don’t have any surprises.
Prescription drug coverage is next in the list. As mentioned before, Part D plans (and not shockingly, any other drug plan) often change their formulary on a regular basis, so you need to make sure your meds are covered.
Much the same as with drug plan formularies, Medicare Advantage plans often make changes to their network of doctors and hospitals (which is the next item in the list). Similar to the HMOs many of us have grown accustomed to, you need to make sure that your Medicare Advantage plan provides you with access to your chosen doctors and hospitals, or viable alternatives. This is a factor to check out annually during the enrollment period.
Focusing on the consumer experience aspect, Medicare’s list includes a consideration for quality of care. If you’re not currently satisified with the care you’re getting from your chosen plan, you should do your research and choose a Medicare plan to improve this aspect going forward.
Lastly, if you travel much (primarily internationally, but state-to-state can cause problems depending on the availability of in-network providers if you’re on a Medicare Advantage plan), you need to review the limitations on coverage for you with the plan you’re using. Most plans don’t provide much coverage internationally, although some Medigap Plans (specifically Plan C, D, F and G) will cover a portion of your medical expenses internationally. Original Medicare (Parts A & B) does not provide international coverage, although you may be able to supplement with additional private coverage to meet this need.
So, as you can see, there are quite a few items to consider in your Medicare plan. It’s not as simple and straightforward as you thought. And as mentioned above, the rules can change regularly, not to mention your own circumstances changing as you age. It doesn’t have to become a full-time job, but it does pay off in the long run to develop and maintain a Medicare plan.
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