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Choose a Medicare Plan for 2018 That’s Right for You
By Daniel Casciato


Bob O’ConnorMedicare is the national health insurance program for U.S. residents 65 and older. It also can cover some people under 65 with certain illnesses and disabilities. The overall program is quite complex, and often premiums and other details can change from year to year. That’s why it’s important to review changes to your Medicare plan each year. This way you’ll be better prepared when 2018 arrives.

“Everyone should look at their health care decision-making as part of their overall planning for retirement,” says Bob O’Connor, executive director of Medicare for Aetna in Pennsylvania. “Those who are already a Medicare recipient should review the plan on a recurring basis to make sure the plan they have today still meets their needs.”

Here are some key things you should consider:

  • Does the plan’s formulary (drug list) cover your medications?
  • Are your doctors and pharmacy in-network?
  • What are the plan’s out-of-pocket costs? (Review the premium, deductible, copays and/or coinsurance.)
  • Is a Medicare Supplement plan right for me?
  • When can I enroll?

Know what your plan has to offer

Many insurance companies update their formulary (drug list) annually. According to O’Connor, some of these changes for 2018 could be more noticeable. For example, some prescription drugs might have a cost increase or may no longer be covered by your plan. That’s why it’s so important to make sure you review your current prescriptions and compare against your plan’s formulary. This will help you see what’s changing next year.

“When you review your out-of-pocket costs, like plan premiums, don’t forget to factor in the cost of drugs,” says O’Connor. “Often, this is an expense that gets overlooked. Keep in mind, just because the drug is covered by the plan’s formulary, it doesn’t mean there won’t be a cost associated (such as deductible or copay).The best thing to do is to discuss your coverage with a licensed broker or agent”.

The more you know, the more likely you are to get the plan that’s right for you. For example, know if your doctors are in the plan’s network. Know if your plan requires you to have a primary care physician (PCP). O’Connor recommends you review all of your options, recognize what your budget will allow and understand what benefits you can expect to use each year.

“Some companies differ in terms of network,” he says. “Understand which facilities, hospitals and doctors you want to access. Make sure your doctors and hospital are in the plan's network.”

Is Medicare Supplement coverage the right choice for you?

“Medicare is a nice safety net, but it still has significant cost sharing, and some people might want help covering those significant costs,” says O’Connor.

Once you have Original Medicare (Parts A and B), see if a Medicare Supplement plan is right for you. Although these plans work alongside your Original Medicare coverage, the premiums can be expensive and will go up over time. The plans also have deductibles and coinsurance that can be expensive. However, there are no network restrictions. So you can use any physician or hospital that accepts Medicare.

If you want to sign up for a Medicare Supplement plan, you can do so during the initial enrollment season. This is a onetime-only, 6-month period when federal law allows you to buy a policy you want that’s sold in your state. It starts in the first month that you’re covered under Medicare Part B, and you’re 65 or older. During this period, you can’t be denied a Medicare Supplement policy or charged more due to past or present health problems. Keep in mind, if you miss this period, Medicare Supplement Insurance plans may check for medical conditions and your premium could be higher.

When to enroll in a Medicare Advantage or prescription drug plan

The initial enrollment period for Medicare lasts for seven months — the three months before you turn 65, your birthday month and the three months following your birth month. You can sign up for Part A and/or Part B during that time.

During your initial enrollment period, you can enroll in:

1.     Part C (Medicare Advantage), with or without prescription drug coverage, once you have Medicare Part A and Medicare Part B

2.     Part D (prescription drug coverage only) once you have Part A or Part B

Just remember, if you wait to enroll in prescription drug coverage, you may have a lapse in coverage and will have to pay a late enrollment penalty (LEP).

If you didn’t enroll during the initial enrollment period, or you want to select a new plan, you can do so during Medicare’s Annual Election Period (AEP). This begins on October 15, and runs through December 7, each year. However there may be other times when you may be able to join, switch, or drop a Medicare Advantage Plan.

If you’d like more information visit www.aetnamedicare.com.

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