Question: I have Medicare and a Medicare Advantage Plan right now. My doctor is running some tests and I may have some serious decisions to make in the coming weeks. What should I do with my insurance coverage?
Answer: I am pleased you are working with your doctor to find out what is wrong and what can be done to make you feel better. I am also excited to tell you that your Medicare Coverage and the options available with it are very useful and comprehensive. As you move through this process it is important to understand you have opportunities to evaluate your insurance coverage and make changes that reduce your exposure to big medical costs.
I have talked often about Enrollment Periods, which are the periods of time that you are allowed to change your insurance choices. You currently have a Medicare Advantage Plan which allows you to switch to any alternative coverage of your choice from January 1 to March 31 each year, known as a Medicare Advantage Plan Open Enrollment Period (MA-OEP).
When you have a Medicare Advantage Plan, you have useful insurance. That insurance product can cover the tests and appointments you are getting done as long as you go through the prior approval process. A Medicare Advantage Plan usually has co-pays for each of those tests, procedures and appointments. In this situation you want to be thinking about what you are having done and where you are having it done. You must consider your network to be assured of effective coverage. You also need to be aware of the costs of those tests, procedures and appointments.
Medicare Advantage Plans usually have inexpensive monthly premiums with co-pays and deductibles for most tests, procedures and appointments. If this situation you are facing is short in duration and is resolved, staying with your current plan could be an appropriate choice. If this situation turns out to be longer and more serious, you may choose to change your current coverage using the MA-OEP now or later in the year using a Special Enrollment Period (SEP) to adjust your insurance to something more comprehensive. That alternative plan could be Original Medicare + Medicare Supplement Plan + Part D coverage. In this alternative situation, your premiums would probably be higher, but the cost for tests, procedures and appointments would likely be less.In a situation where you have a serious medical problem, you may also want to go to a larger pool of providers and hospitals. Original Medicare allows you to you see almost any doctor, anywhere in the country. Referrals are not usually required for prior approvals for testing that is ordered by the physician. This can sometimes make treating a serious illness easier to handle.
With most Medicare related changes to your insurance coverage, the start date of the new plan is the first of the month following your change. Thinking of your plans specifically, talk with your physician, your support system and those that help with your insurance coverage. Evaluate the alternatives and make a change if it makes sense for you and your situation.
I wish you luck and positive outcomes for all that happens. Remember that insurance can be adjusted in many ways to better address what is happening in your life. The change you make can also be changed again as other Enrollment Periods and Special Enrollment Periods happen throughout the years. No one insurance product is perfect for everyone and every situation as we age. Your Medicare insurance coverage should be adjusted as your situation changes.
Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call us at 716-720-9797 or e-mail at SLM@lutheran-jamestown.org.