Mailers, phone calls, invitations to events — if you’re nearing 65, the age when you can access Medicare, you’re probably getting bombarded with information. Daniel Core, owner of Core Insurance Pro, a health insurance broker agency in Tallmadge, recommends doing some of your own research with credible sources ahead of the open enrollment period, which is Oct. 15 to Dec. 7 this year, to prevent yourself from getting overwhelmed.
“The best way to do it is to go to your local library, find a ‘Medicare & You’ handbook, and also go to medicare.gov,” says the licensed insurance agent. “Explore the plans, then try to find the broker that is going to be a good fit.”
Core was the No. 1 agent in the United States for selling Medicare Advantage plans for one of the top carriers in the country, so he knows what people should be keeping an eye out for.
“People would be on the phone like, Oh my gosh, you saved me so much money on prescriptions. I couldn’t even afford food or to go to the pharmacy,” he says. “This industry does have an impact.”
Core provides expert tips on picking a Medicare plan that best fits your needs.
Back to Basics
Medicare Parts A, B, C, D and G — it’s important to know the basics.
Medicare Parts A and B, which are always joint, cover hospital visits and doctor visits, respectively. With them, you can visit any doctor or hospital in the United States that accepts Medicare, which can be beneficial if you snowbird or travel a lot. Medicare Part C is the Medicare Advantage plan. Both Parts A and B and Part C can include Part D prescription coverage. Medicare Advantage also includes benefits like hearing and dental plans, gym memberships, traveling benefits, set emergency room copays, some skilled nursing facility coverage, free over-the-counter medications, free or low-cost doctor and specialist copays and more. Often, under Medicare Advantage plans, age-appropriate labs and tests are free or up to $20 each, and medical supplies like diabetes testing supplies are free or up to 20 percent of their usual costs. There are more network stipulations, however, so you can only visit doctors who are in your plan’s network.
“Most people think that when you go on a Medicare Advantage plan, you’re losing Parts A and B, which isn’t true. It’s subsidized by Medicare to give you the additional benefits,” Core says. “Overall, Medicare Advantage is one of the most all-inclusive, affordable coverages that exist.”
Your coverage through Parts A and B or Part C can also include Part G, which can be especially helpful for people with frequent doctor visits. Part G, also known as Medigap, is a supplement that can be beneficial for people with specific needs that may amount to high medical bills otherwise.
“If they go to the doctor every day, or multiple times a week, then they need to go to a supplement plan so they don’t have high out-of-pocket costs,” Core says. “That person gets to make that choice of which plan would be the most suitable for them.”
On the Lookout
There are three main things to check when selecting the Medicare plan that fits you best — prescription drugs, specialty doctors and preferred hospitals. You or an insurance broker can enter any of that information into the system and check which plans offer the most coverage for your specific situation.
Many older adults have multiple
prescriptions, and if the costs aren’t covered, they can be very high.
“A lot of the plans that people enroll in, they don’t realize that their drugs, eventually, based on how much they are, could hit a coverage gap,” Core says. “That’s usually the rule of thumb: We want to make sure that drugs are going to be affordable.”
New this year, the cost of a one-month supply of insulin caps at $35 under Part D, according to medicare.gov.
It’s also important to check that your doctors, especially if you have specialists you visit, remain in-network if you have Medicare Advantage. If the doctor switches locations, you can switch plans, and Core Insurance can help you consider that as an option.
“You want to make sure that your doctor that you’ve been going to for let’s say 15, 20 years, they’re in that network,” Core says, adding that if you have a hospital or pharmacy you prefer, you’ll want to make sure those are in-network too.
When to Act
You should access Medicare as soon as you can.
Typically, you have to be 65 or older, but people with a disability, end-stage renal disease and ALS can often access it before they turn 65, according to the U.S. Department of Health and Human Services. Often, people don’t enroll in Medicare right away because they still have benefits through their employer or their spouse’s employer, but Core advises you to not wait.
“Even if they have employer benefits, it could be beneficial for them to explore other Medicare plan options,” Core says, adding that waiting might make you pressed for time and overwhelm you. “You won’t be able to really make a clear decision when it comes time to enroll. You’ll make a quick decision. So it’s best to start early.”
If you plan ahead, you should feel equipped with knowledge before the open enrollment period Oct. 15 to Dec. 7. If you miss it, there’s a late sign-up period, or Core Insurance can help you get on a temporary short-term medical plan. But if you feel like you don’t have time to sit down and do a bunch of research, you can keep an eye out for Core Insurance kiosks at places like the Center of Hope in Ravenna. Filling out some basic information about yourself can lead to an appointment with a broker from the company, which will allow you to get help and guidance quickly. With these kiosks, Core Insurance hopes to meet people where they are, especially in underserved areas, Core says.
“They’ll be able to kind of skip the line and not have to go through the process of calling and scheduling,” he says. “We will reach out to them and then give them whatever help they desire.”
Overall, he recommends that you consider all of your Medicare options and reach out to a professional if you have any questions or concerns.
“Make sure you secure that because it’s your right,” Core says. “You’ve paid into it for working in the United States of America, so that’s something to be proud of.”
[ Assistant Editor Alexandra Sobczak is passionate about inclusivity, correct grammar and pop music. ]
Comments? Email them to Kelly Petryszyn
[kpetryszyn@bakermediagroup.com].
