5 Ways to Maximize Your Medicare

These five ways to get the most out of your Medicare, can help you keep costs down while getting good care. They might even help you live longer and better!

DID YOU KNOW: Healthcare costs make up about 17% of our country’s entire GDP, concerning many of us with having access to affordable healthcare. Companies and individuals are looking for ways to keep costs down — and for most folks aged 65+, Medicare is an important piece of the puzzle. There are roughly 58 million enrollees in Medicare and with over 326 million people in America, that’s a hefty 18% of the population — nearly 1 in 5. projected to rise to 79M by 2030. Since it’s in the cards for most of us, here are five valuable ways to maximize your Medicare:

 

1. Enroll at the right time — being late can cost you.

If you’re late enrolling in Medicare, your part B premiums (which cover doctor/medical services) can rise by 10% for each year that you were eligible for Medicare and didn’t enroll. There’s also a penalty related to Part D (prescription drugs) for late enrollment as well. If you don’t enroll in your Initial Enrollment Period, most likely you will have to wait until the General Election Period to enroll, which is Jan 1 – Mar 30, with July 1 being the effective date. There are many clients who don’t understand Medicare and don’t seek help and/or guidance, who fall into this this trap.

When should you enroll? Well, you’re eligible for Medicare at age 65, and you can sign up anytime within the three months leading up to your 65th birthday, during the month of your birthday, or within the three months that follow. Also, you can enroll in Medicare if you’re under 65 and have been on disability for 24 months.

There’s a helpful loophole, too: If you’re among the many Americans who are already receiving Social Security benefits by the time they reach age 65, you should be enrolled in Medicare automatically. You might also avoid the late-enrollment penalty and be able to skip the deadline if you’re still working, with employer-provided healthcare coverage, at age 65, or if you’re serving as a volunteer abroad.

2. Choose wisely between “Original” Medicare, with a Medicare Supplement plan or a Medicare Advantage Plan

There isn’t a single Medicare plan that’s going to be a fit for everyone. Each enrollee needs to make some important decisions — with the primary one being whether you opt for “original” Medicare with a Medicare Supplement Plan or a Medicare Advantage (MA) Plan. Traditional or “Original” Medicare features Parts A and B that respectively cover hospital expenses and medical expenses. If you opt for it, you’ll likely have to add a stand-alone Part D, which offers prescription drug coverage, including insulin supplies. Instead of opting for parts A, B, and D, though (which leaves you exposed to gaps in coverage with the potential for enormous out of pocket expenses), you should consider either a Medicare Supplement or Medicare Advantage plan, sometimes referred to as Part C (but you can’t have both).

Offered by private insurance companies, Medicare Advantage plans are required to provide at least as much coverage as Parts A and B — and some usually offer more benefits, like hearing, vision, dental care, and prescription drug coverage (where original Medicare does not). Many plans have a $0 monthly premium and they cap your out-of-pocket expenses, but they can be as high as $6700 (in network) and up to $10,000 (out of network). An example of this would be a $6000 expense for an out-patient 8-week chemotherapy treatment that was $30,000, since you would have to pay 20% of the Medicare approved cost. Once you have met the maximum out of pocket, then the plan would pay 100% after that. This is another reason why it is so important to choose the right plan when you become eligible for Medicare.

While original Medicare will often have you footing 20% of many bills with no end in sight, a Medicare Advantage plan might charge you a low copay per doctor visit or service, with the total amount you’ll pay limited. While original Medicare lets you see any healthcare provider who accepts Medicare, Medicare Advantage plans will typically limit you to a network of doctors — though some networks can be extensive. When you review the plans you’re considering, see which drugs they cover, and which doctors are included — and how much you’ll likely spend out of pocket with each one. The Medicare Plan Finder at the Medicare website can help you compare and choose or you can seek the help of a qualified insurance agent who specializes in Medicare planning. Note the star ratings of your candidate plans and favor four or five-star plans. Keep in mind that you can change your mind once a year, during the annual enrollment period (Oct 15 – Dec 07), and can switch between plans.

Another option you have is choosing a Medicare Supplement plan also offered by private insurance companies. Today, there are 10 standardized plans to choose from; however, plans F and G are the most comprehensive. They’re called “Cadillac” plans since there are typically no out of pocket costs, except for the monthly premium. With Plan G, you do have to pay the Part B deductible only once each year ($183 for 2018). Both plans cover foreign travel and both plans cover the excess doctor charges as well. Due to MACRA (Medicare Access and CHIP Reauthorization Act), Plans C, F, and HDF are going away for new beneficiaries on Jan 01, 2020. If you are on those plans before Jan 01, 2020, you will be grandfathered in and get to keep them. There are some Supplement plans that start as low as $46/month that have an annual deductible (or maximum out of pocket). Don’t consider a company just based on the lowest price, also consider their length of time in business, financial stability, as well as their rate stability. Rate stability is a big factor since we are living longer these days! I remember our parents always telling us, “You get what you pay for”!

3. Consider telehealth services if you can

Many plans these days offer enrollees telehealth services. These permit patients consult with doctors and other healthcare professionals electronically, often via a Skype-like video connection. These consultations can cost less than an in-person visit to your doctor and can be more convenient, too, saving you from having to make an appointment a few days away, travel to your provider, and spend time in a waiting room. You can typically have a consultation immediately or within hours. This can be especially useful if you’re traveling when you need a doctor or medical help.

Telehealth services aren’t available to every original Medicare enrollee, but it’s available to some. Some Medicare Advantage plans offer it, too.

4. Get screened…you owe it to yourself

Once you’re in a Medicare plan, make the most of the screenings and preventive care that are available — typically at no cost to you. Doing so can help identify problems early, before they grow worse and become costlier. (A polyp caught early via a colonoscopy can prevent lots of heartache and costs down the road.) Screenings can keep you healthier and living longer and better, while keeping your healthcare costs down. Some of the services that should cost you no additional dollars (though some require doctor’s orders) include: abdominal aortic aneurysm screening, alcohol misuse screening and counseling, bone density measurement, cardiovascular disease screenings, cervical and vaginal cancer screenings, colonoscopies and other colorectal cancer screenings, depression screenings, diabetes screenings, flu shots, hepatitis B shots and hepatitis C screenings, HIV screenings, some home health services, lung cancer screenings, mammograms, nutrition therapy services, obesity screenings and counseling, pneumonia vaccine, prostate cancer screenings, sexually transmitted infection screenings, and smoking and tobacco-use cessation counseling.

5. Make the most of wellness benefits

Finally, aim to get well and/or stay well via wellness benefits included in your Medicare coverage. For starters, all new (Part B) enrollees are entitled to a one-time “Welcome to Medicare” preventative visit within the first 12 months as well as one wellness visit annually, at no extra cost to them. That’s when you can see your primary care doctor to review your health. Don’t skip this, as it gives your doctor a chance to discuss ways to get you healthier instead of just ways to treat the illness or injury you walked in with. You may have access to other health benefits and perks, too, such as discounts on gym memberships. Find out what your plan offers and make the most of those benefits. To maximize your Medicare, don’t just wait until you’re not feeling well to visit your healthcare provider. Instead, take advantage of all the care you’re entitled to, such as preventive screenings and your annual wellness visit.

It can’t be stressed enough how important it is to get your Medicare right the first time. When you are turning 65, this is your Initial Enrollment Period which gives you a “GUARANTEED ISSUE” right, meaning no underwriting questions can be asked and you can’t be turned down due to your health. Even if you already have Medicare, it’s always a good idea to have a Medicare review done every couple of years just to see if you have the most suitable plan available, as plans and premiums do change frequently. Make sure you do some research and seek the help of a qualified licensed insurance agent who has experience and specializes in Medicare planning. You don’t have to go it alone. One more thing, CONGRATULATIONS on making it to this chapter in your life. You deserve to have the best ‘Quality of Life & Health’.

Note: Further information on Medicare can be found at https://www.medicare.gov. This document is for informational purposes only, and should not replace the advice of an insurance professional who can help you evaluate your individual coverage needs.