Individual needs vary, but here are five steps everyone should follow when choosing a plan:
1. Know your options. There are two ways to get Medicare coverageby choosing Original Medicare from the federal government (with optional supplemental coverage from a private insurer) or choosing a Medicare Advantage Plan from a private insurer.
Original Medicare includes hospital coverage, which is Part A, and medical coverage, which is Part B. With Original Medicare, you can add supplemental coverage from a private insurer for either a Prescription Drug Plan (Part D) or Medigap coverage to limit out-of-pocket expenses.
Medicare Advantage plans (also referred to as Part C) are available from private insurers and provide the same coverage as Original Medicare (hospital and medical) and can also include additional benefits or lower copaymentsfor example, Advantage plans frequently include prescription drug coverage (Part D)while also including out-of-pocket limits to protect you in the event of costly care or treatment.
2. Make three lists: your healthcare needs, medications, and doctors and pharmacies.
" Healthcare needs: What healthcare services do you use regularly? How often do you see your primary care physician and specialists? Are you anticipating any special needs, like surgeries? Make sure these services are covered and compare out-of-pocket costs like copayments, coinsurance and deductibles.
" Medications: Check each Medicare Prescription Drug Plans drug list (also known as a formulary) to make sure your prescriptions are covered and compare out-of-pocket costs (and ask your doctor about generic versions of drugs that may work equally well).
" Doctors and pharmacies: Check to see if they participate in the networks of plans youre considering.
3. If you travel, consider a plan with out-of-network benefits. You may need Medicare coverage that will travel with you. Check to make sure the plans youre considering allow you to receive coverage outside of their network and cover emergency care outside the US if travel takes you abroad.
4. Carefully examine copayments and deductible charges. If you dont anticipate many medical expenses, you may benefit from a plan with a low premium or no premium at all (also called $0 premium plans). These plans often have higher out-of-pocket expenses than plans with premiums, but may be more cost-effective if you dont use many services.
5. Dont forget about preventive and wellness services. The focus in healthcare today is shifting to staying well, not getting better. More preventive services, including mammograms, colonoscopies and wellness visits, are now covered by Medicare without coinsurance or deductible charges. Some plans are offering additional covered benefits like $0 copays for generic drugs, $0 copays for doctor visits within coordinated care networks (also known as patient-centered medical homes), low-cost fitness programs and allowances for vision hardware.
For more information about Blue Cross & Blue Shield of Rhode Islands Medicare plan options, call 1-855-351-ZERO (9376) or TTY/TDD 711, seven days a week, 8:00 a.m. to 8:00 p.m.