By Deborah Jeanne Sergeant
Many people feel confused when choosing a Medicare plan. The numerous options and industry jargon can make plan selection challenging.
Fortunately, area Medicare experts can help guide those new to Medicare or those changing plans during the current open enrollment period, which ends Dec. 7.
“The number one thing is that the local support,” said Cathy Aquino, vice president of Medicare Consumer and Small Group Markets at Independent Health in Buffalo. “Our advisers are there from the beginning of their journey, for those who are new, so we can sit down and look at their medical needs for next year.”
She advises clients to bring their list of their prescriptions and medical providers. They should also consider discussing their present and future health needs. Beyond the basic Medicare, the additional plans vary depending upon company and type of plan. In addition to medical needs and prescriptions the plans cover, Medicaid subscribers should consider their comfort level with health conditions. Some want to see their doctor for every twinge; others are more wait-and-see types who seldom want to use their medical coverage.
“People shouldn’t wait until the last minute,” Aquino said. “People can come in early. We want to make sure they’re all set.”
Aquino also looks at whether a policyholder’s doctors will be covered with the plans they consider. Most people want the comfort of continuity of care. It is also vital for those who travel to ensure that they will receive coverage for non-emergency healthcare needs away from home.
Typically, HMOs will not cover routine issues addressed out of network. PPOs may offer some coverage, making these kinds of plans more suitable for people who travel.
Nancy Nimmo, individual and senior health benefits consultant at Lawley Insurance in Buffalo, looks at travel benefits to ensure that clients can meet non emergency healthcare needs when away from home.
“When you’re going out of the area, you want to make sure you’re covered,” Nimmo said.
She also wants clients to stay in touch in case anything has changed with their prescriptions or providers so they can look at the available plans during open enrollment or, if possible, accommodate the changes. She believes that Medicare health planning is so customized that people should avoid companies advertised on TV and through mailers.
“The plans on ads may not even offered in the service area,” Nimmo said. “Once you call in, they may steer you towards a different plan. Use a trusted adviser to make sure you are enrolling into the right plan.
“I recommend choosing a Medicare plan based on your needs, budget, and your health and making sure your providers participate.”
Insurance plans continually change and upgrade their products and many grandfather in clients with outdated plans. Merely discussing what is new does not place policyholders under obligation to change their plans.
“They often don’t look at what is available,” said Sally Stier president of Clarity Group in Depew, Blasdell, Amherst and Batavia. “Maybe they’re perfectly happy with the plan they have. But there could be something new they’re not aware of. It’s recommended to take a look at what’s new in their current plan and what else is available. Some people are eligible for financial assistance which can affect what plan will be best for them.”
She added that some veterans use the VA for much of their medical care but sign up for Medicare for certain elements: a strategy that may offer well-rounded coverage.
“We try to look at the person’s individual situation,” Stier said. “Even with a husband and wife, they don’t have to have the same plan. They have different health needs. Many people don’t realize that.”