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 many 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 resources available, so you have all the information you need to make an informed decision.
Who’s covered
Individuals 65 and older (and some younger people with disabilities or who need dialysis) are usually eligible for Medicare coverage. Those eligible must re-enroll for Medicare each year. Enrollment in a plan may be limited to certain times of the year unless you qualify for a special election/enrollment period or you are in your Medicare Initial Election Period.
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 Insurance) – Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care and home health care.
Part B (Medical Insurance) – Helps cover doctor’s services, outpatient care, home health care, durable medical equipment and many preventive services.
Part C – Medicare Advantage Plans, sometimes called “Part C”. These plans combine your Medicare Part A and Part B coverage and usually include Part D into one convenient plan, and may offer some extra benefits like vision, hearing, and dental services.
Part D – Prescription drugs.
How to choose a Medicare plan that’s right for you: Coverage Options
Original Medicare (consists of two parts, Medicare Part A and Part B)
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 (Part C)
Individuals who choose a plan enroll through Medicare-approved private insurance companies. They typically pay copays, instead of coinsurance, meaning they pay a fixed cost for health services. These plans often have narrow networks, so make sure your preferred doctors and hospitals are covered.
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 sign up for Original Medicare can also pay for Medicare Supplement Insurance—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.
UCHealth resources
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 enroll online or call 1-855-919-1187 (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.
Government resources:
‘What’s Covered’ App
Medicare’s “What’s Covered” app helps individuals quickly see whether Medicare covers their doctor, facility and health services. Find it in the App Store or on Google Play.
State resources
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.