By Carolyn Spence Cagle PhD, RN-E
Your recent mailbox offerings serve as a “call to action” to make choices for your 2019 health insurance coverage during Medicare Open Enrollment October 15-December 7, 2018. Although your current Medicare policy (basic health insurance, Medigap, or Medicare D) may have met your needs, “looking around” in the following ways for other insurance options will inform whether you will continue or change your current coverage for 2019 for the best outcome::
- Closely read the Medicare & You 2019 book. An overview of “original Medicare” (the 80/20 plan) and “Medicare Advantage” plans appears on pp. 5-7 to minimize confusion about differences in the two basic Medicare approaches. Choose the “right plan” for you based on your history of and predicted needs for 2019.
- Find easier navigation of health care topics in the 2019 Medicare & You 2019 book. Take time to identify no-copay (you owe noting), coinsurance or deductible benefits focused on prevention of illness. Only half of Americans use those benefits, including the annual “wellness” visit, known to cut costs in preventing illness and managing chronic illness management. Book section 11 allows you to easily compare health and prescription (drug) plan specifics for your local area (monthly premiums, cost of primary vs. specialist visits, drugs, etc.)
- If you have a Medicare Advantage plan (HMO or PPO), closely read the “Provider & Pharmacy Directory, Comprehensive Formulary (listing of covered drugs at various tiers), and Annual Notice of Changes for 2019.” I discovered reading the formulary that one of my current tier 1 drugs (my lowest co-pay) will move to tier 4 (my highest co-pay) and that acupressure will become a covered benefit in 2019. Needless to say, I will work with my primary care doctor to find a medication that is costs me less in 2019.
- Talk to others in your community about plan satisfaction and reasons why they have stayed with that plan or changed based on experience.
- Use Via Benefits, contracted with TCU, to help identify plans services and drugs that best meet your health and financial needs. You may also visit Medicare.gov/find-a-plan or call 1-800-633-4227 (1-800-MEDICARE) to find the best health and drug policies for you or locate a state health insurance assistance program (SHIP) for individualized health insurance help. Check also with your current health care plan for valuable information. These resources will help estimate out-of-pocket costs and also provide you customer evaluation ratings from current plan members.
- Plan for the Medicare D “donut hole” to close for brand-name drugs in 2019 and the “hole” for generic drugs to end in 2020. Shop around for the best plan (only 10% of retirees do each year) and use drug discount cards or Goodrx.com online offers to further save prescription costs.
- Know that Medicare will cover more benefits in 2019: no cap on therapy benefits with “original Medicare,” telemedicine to improve care for those with end-stage renal disease care or stroke, and cost of life-style support (in-home help, meals, transportation, etc.) in some Medicare Advantage plans.
References:
Marsh, T. (2018, March 29). 8 ways to make the most of Medicare. Retrieved from http://www.GoodRx.com.
Mul, K. (2018, May 22). How this couple uses GoodRx to avoid the Medicare donut hole. Retrieved from http://www.GoodRx.com.
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. (2018, September). Medicare & You 2019 (CMS Product No. 10050-16). Washington, DC: U.S.