If you’re 65 or older, you’ve probably been inundated with information about Medicare’s annual election period. While Medicare is complex and there are thousands of plans to choose from, it’s important to take time to sort through all the noise and select the plan that works best for your individual needs and circumstances.
“Choosing a Medicare plan is an often daunting and very complicated decision that needs to be tailored to an individual’s needs,” says Kelly Henry, senior director of Payer Strategies at UCHealth.
Read on for a quick primer and list of free resources available, so you have all the information you need to make an informed decision.
Individuals 65 and older (and some younger people with disabilities or who need dialysis) are usually eligible for coverage. Those eligible must re-enroll for Medicare each year.
The A, B, C’s — and D’s
Medicare has four parts: A, B, C, and D. Looking broadly, each cover different things:
Part A – Hospital care
Part B – Doctors, procedures and equipment
Part C – Combines Parts A, B and D into one convenient plan, sometimes referred to as Medicare Advantage. These plans may also include vision, hearing, dental and/or health and wellness programs.
Part D – Prescription drugs
How to choose a Medicare plan that’s right for you: Coverage Options
Medicare (sometimes referred to as Original Medicare)
Individuals pay 20% of cost/coinsurance for health services. Typically covers any provider or facility that accepts Medicare.
Individuals often choose Original Medicare and add a Prescription Drug Plan, with or without a Medicare supplement to fill in coverage gaps.
Medicare Advantage (Medicare Part C)
Individuals who choose this plan enroll through private insurance to receive coverage for Parts A, B and D, and potentially other health services. They typically pay copays, instead of coinsurance, meaning they pay a fixed cost for health services. (These plans are sometimes offered at a $0 or low-cost premiums so individuals may pay little or nothing for doctor visits, hospital stays, prescription drugs, dental care, eyeglasses and contacts and fitness classes.) These plans often have narrow networks, so make sure your preferred doctors and hospitals are covered.
Medicare Advantage is growing in popularity, with nearly 40% of eligible Coloradoans choosing a Medicare Advantage plan last year. Individuals with special health circumstances, like diabetes, may be able to find a plan here that offers extra benefits such as free insulin. Dual eligible patients may also consider this plan for coverage needed beyond what is offered with Medicaid.
Medicare Supplement Insurance (sometimes called Medigap)
Individuals who buy Original Medicare can choose to pay a premium—in addition to what they pay for Medicare Parts A, B and D—to protect them from additional costs they might incur.
This is extra insurance is purchased from a private company and does not cover dental, vision and certain other health services, nor does it typically cover prescription drugs.
If you’re feeling overwhelmed in making Medicare decisions, you’re not alone. UCHealth has partnered with an independent insurance broker to help you navigate your choices.
“We want to ensure our patients have easy access to resources to help them navigate the process and understand what is covered so they have all the information they need to choose a plan that is right for them,” Henry says.
Compare Medicare plans in your area, find answers to questions and get personalized plan recommendations online or call 855-919-1186 (TTY 711) to speak with a licensed insurance agent at no cost. If you prefer to speak with a local insurance representative, you can call UCHealth’s local partner, Fidelis Consultants, at 303-562-1562.
UCHealth Community Health Improvement is a designated site for the State Health Insurance Assistance Program, or SHIP, in Larimer and Weld counties. Through the UCHealth Aspen Club, counselors assist people, free of charge, with their Medicare benefits and help to answer questions objectively.
‘What’s Covered’ App
Colorado’s State Health Insurance Assistance Program (SHIP) is part of a national, federally-funded network offering free health benefits counseling for Medicare beneficiaries and their families. Call 888-696-7213 for more information.