Medicare can be a great resource for helping those manage their chronic conditions and illnesses. However, with open enrollment right around the corner (October 15 to December 7), you should check in on your overall coverage to ensure you get the benefits you need.
David Lipschutz, the Associate Director for the Center for Medicare Advocacy, says, “You should focus on the whole picture, not just the bells and whistles…What does the provider network look like? What are the cost-sharing and the maximum out-of-pocket amount? Are my drugs in the formulary?”
One of the most important things to keep in mind is to ensure you can still see your doctor. When choosing between the original Medicare plans and Medicare Advantage plans, keep in mind what they both offer. Medicare allows you to see any provider or hospital that accepts Medicare without a primary care service provider referral. However, with Medicare Advantage plans, you will need a physician referral.
Take note of any out-of-pocket costs you may have. Next year, the average premium through Medicare Advantage plans will sit at $19 per month. However, traditional Medicare will cost $33 a month on average and may need to add a Part D plan or Medigap to help supplement the cost.
If you want to switch, know you may have difficulty going back to your original plan if you find you do not like the new one. If six or more months have passed since enrolling in Medicare Part B, Medigap insurers may charge you more or even deny coverage for conditions deemed preexisting, making coverage more difficult for those with preexisting conditions.
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