Open enrollment for Medicare will begin this October. If you are approaching 65 years or are older, do you know your options?
Kimberly Bloir is an Insurance Specialist at Visiting Nurse Association of Ohio. “It’s difficult to think about these types of questions when you’re healthy,” she says. “But it’s important for people to make these decisions before they require healthcare services for an illness or disease.”
So, where do you even start? Bloir says, “First of all, you’ll need to make the decision to choose between traditional Medicare and Medicare Advantage plans.” Each option has pros and cons. “It’s a good idea to start by making a list of all your medical insurance claims from the past 12 months. This will help you get a sense of the types of claims and the provider, which will shed light on your potential future medical needs,” she said.
With traditional Medicare, your healthcare coverage comes straight from the Federal Government. A handful of service providers will be assigned based on the state. Your local Social Security office is a great resource. They can help advise you on who the providers are for your area. It’s important to note that you’ll need to purchase a separate pharmaceutical plan to cover prescription drug medications that you might need.
With a Medicare Advantage Plan, a third party provider will be covering your expenses, and your payments will go directly to them.
When researching plans, Bloir says that it’s just as important to consider the deductible as well as the premium. “In many cases, depending on the type of services you might need, the deductibles might end up being more than what you’d be saving with a lower premium.”
Researching the right plan for you is important, especially if you are considering staying with your family doctor or a specialist that you trust. That doctor or specialist may be out of network and may end up costing you more with traditional Medicare or Medicare Advantage.
However, Bloir stresses that having a doctor you can trust is very important. “You have to be your own advocate for healthcare,” she says. “But having a doctor or specialist that you trust can help you feel confident about all of your options when dealing with an illness or medical issue. For some people, the reassurance is worth the additional out-of-network expenses.”
It can be very difficult to be your own proponent of self-care, Bloir says. “Unless you’ve been through a scenario, you’ll never know every question you need to ask when signing up with an insurance company.”
The best advice, she says, is that once you decide on an insurance plan, you should always be the one making the calls directly to the insurance company. “There’s too much turnover in healthcare for them to know every little question to ask,” Bloir says. “You can’t depend on your providers to always know what to ask on your behalf so, instead, you can call them directly or have a plan in place for a family member to call on your behalf.”
Finally, it’s critical to have a specific plan in place in case of a medical emergency. “It’s difficult to talk with loved ones about what to do in a medical emergency but it’s so important,” Bloir says. “It is crucial for the patient and the family member to know how to respond quickly and assertively in a medical emergency.”
Check out our guide on Advance Directives in Ohio.
“As providers, we get into grid lock if we don’t follow all the rules. Patients and family members have to be reactionary when emergencies arise and a lot of times, they’re not prepared.
“Things are changing so rapidly and quickly,” she says. “Check the Medicare.gov website frequently. Your family doctor is also a great resource for you. If you have questions about home healthcare specifically, we are always glad to talk through it with you over the phone.”
Additional resources:
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