Choosing a plan: Medicare Enrollment terms and tips

As inflation in the U.S. remains high, you may be looking to adjust your lifestyle and spending habits. Medicare’s annual enrollment period, Oct. 15 through Dec. 7, is an opportunity to assess your overall health care costs to help ensure you choose a plan that will work best for next year’s budget.

Below are five tips, including important terminology, to consider when choosing a plan that may help lead you to better health and cost savings:

1. Consider all your options. Take time to understand and compare the benefits, services and costs of each plan available to you, so you can figure out which will be the optimal fit. Pay attention to more than just the monthly premium, including charges that could arise from out-of-pocket costs such as the deductible, copays, and coinsurance.

2. Learn the language. Choosing a Medicare plan can be challenging, so understanding the terminology is key.

• Original Medicare is provided by the government and includes Part A, hospital coverage that helps pay for inpatient care, skilled nursing facilities, hospice care and home health care. Part B is medical coverage that helps pay for outpatient services from doctors and other providers, preventive services and medical equipment like wheelchairs and walkers. You can add a Medicare Advantage plan called Part C or a Medicare Supplement, also referred to as Medigap. Both are offered by private insurance companies approved by Medicare.

• Medicare Advantage plans combine Parts A and B into one comprehensive plan. These plans often include prescription drug coverage (Part D) and offer benefits not provided by Original Medicare. They are suited for those who are generally in good health and don’t expect a great deal of medical expenses.

• Medicare Supplement plans cover some of what Medicare Parts A and B do not cover, such as portions of coinsurance, out-of-pocket costs, copayments, and deductibles. These plans may be good for seniors who have significant health issues and out-of-pocket costs.

3. Help prevent financial surprises. Visiting doctors that are in-network is one way to help keep your costs lower. Before selecting a plan, check to see if your doctor is in your health plan’s provider network. Also, make sure your medications will be covered by the plan you choose next year, and consider filling your prescriptions at a participating network pharmacy or with home delivery by mail.

Original Medicare doesn’t generally cover prescription drugs. Consider adding Part D or enrolling in a Medicare Advantage plan with prescription drug coverage to help keep your medication costs in check.

4. Consider specialty benefits. Original Medicare doesn’t cover most specialty services, but many Medicare Advantage plans do, and these benefits contribute to overall well-being.

5. Avoid waiting until the last minute. Start early and give yourself enough time to make the decisions that will be right for you.

To get connected with a licensed insurance agent, call 1-505-456-0060. For full information on enrolling in Medicare plans, you can review the CMS website at www.medicare.gov or call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/seven days a week.

Mike Wallace is vice president for Growth & Strategy at Optum New Mexico, and is also a licensed New Mexico health and accident insurance producer.