Medicare Open Enrollment: Things to Think About When Comparing Plans

By Jonathan Blum, Deputy Administrator for Medicare

Every day we are faced with choices.  We check the weather forecast to help us decide what to wear.  We might look over the supermarket sale ad to help us figure out what to have for dinner.  I’ll bet that sometime today, without even realizing it, you’re going to gather some information and use it to help you make a decision.  Some of those choices might be harder than others.

In my work with the Medicare program, I know that choices are a good thing.  But I’m also aware – because some of you have told me — that sorting through your health and drug coverage choices during Open Enrollment can be confusing — especially when many Medicare plans seem to offer similar benefits.

That’s why making Medicare easier to access has been one of our top priorities. The Affordable Care Act is helping us do this, in addition to delivering better choices, more benefits, and lower overall costs to the Medicare program.

We’ve been working to make Medicare less confusing by steadily phasing out duplicative plans, and shoring up our website, toll-free call center and community programs to make it easier for people to find Medicare coverage that works for them.

This year, when you sit down to review your Medicare health and drug plan choices, here are some things I hope you think about:

Are the services you need covered?

We know future health care needs can be hard to predict, but changes happen. Maybe your family situation is different this year, or you have different health concerns. Make sure you understand what services and benefits you’re likely to use in the coming year.

Remember that no matter what plan you pick, you’ll have access to a variety of preventive tests and screenings, at no cost to you, thanks to the health care law.

Do you have any other coverage?

You may have other health insurance from a current or past job, or through a family member.  If you do, you’ll want to understand exactly how that other coverage works with Medicare. You may want to just keep what you have.

Costs

How much are your premiums and deductibles? How much do you pay for hospital stays and doctor visits? Is it important for you to have expenses balanced throughout the year?  Just like with everything else, the lowest-cost health plan option might not be the best choice for you.

Doctor and hospital choice

We understand the relationships you have with your doctors and providers are important. Do your doctors accept your coverage? Do you have to choose your hospital from a network? Do you need to get referrals?  With Original Medicare, you can always go to any doctor or hospital that accepts new Medicare patients.

Drug coverage

Do you need to join a Medicare drug plan? Will you pay a penalty if you join a drug plan later? How much will your prescriptions cost under each plan? Even if you don’t take many drugs now, you might want the peace of mind of knowing you’re covered.

Quality of care

Ask yourself whether you’re truly satisfied with your medical care. Not all health care is created equal, and the doctors, hospitals and facilities you choose can impact your health. Look for plans with a 5‑star performance rating — the right expertise and care may help speed your recovery and improve your outcomes.

Convenience

Your time is valuable, too. Where are the doctors’ offices? What are their hours? Which pharmacies can you use? Can you get prescriptions by mail? Do the doctors use electronic health records or prescribe electronically? Remember that even if you are happy with your current plan, these answers might change from year to year.

Travel plans

Maybe you travel a lot, or spend part of the year in a different state. If you do, make sure you know whether your coverage will travel with you.

Only you know what’s most important to you and your family – that’s why we want to make sure you have all the information you need to make the best decision for you.  Look around for all the Medicare information out there [link to second blog in series]. And visit our Open Enrollment center, where we’ve gathered everything you need to walk through your options.  Now, what’s for dinner?