5 Tips to Getting the Most Out of Medicare During Open Enrollment

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Medicare open enrollment is in full swing, and if you're trying to figure out how to make the most of Medicare in 2017, we're here to help. While everyone's situation will be different, here are five ways that you may be able to take advantage of open enrollment to improve your plan and save money.

1. Watch the clock

Medicare open enrollment gives you a chance to crunch the numbers, consider your health, and compare Medicare plans to make sure that your coverage is what you expect when you need it.It can take a lot of time to consider the various pros and cons of the plans available to you, so don't wait too long to do your research. The open enrollment period this year runs from Oct. 15 to Dec. 7.

Fail to make a decision within this window of time and you could get stuck with your current coverage for another year. That may not be a problem, but it could expose you to big out-of-pocket expenses if you get sick or injured and your plan is no longer your best option.

Remember, Medicare is an important safety net, but it doesn't pay for everything. Medicare Part A covers hospitalization, but only after a deductible, and after 60 days, you begin paying increasingly more for your treatment. Part B includes deductibles and you have to pay 20% of your healthcare costs.

Switching to a Medicare Advantage plan may offer you better levels of cost sharing and an out-of-pocket limit that can reduce your total healthcare expenses in a given period. Adding a Medigap plan during open enrollment could offer you some protection against out-of-pocket costs, too. Therefore, it's important to review your options sooner rather than later, so that you have the time necessary to make an educated decision.

2. Get some help

Medicare's ins and outs can be confusing. Fortunately, Medicare provides services that can help seniors better understand how Medicare works and what options are available to them. Medicare can be reached via phone at 1-800-Medicare, and it provides a handy Medicare Plan Finder tool online, which you can view here.

If you're going to call Medicare, consider calling during off-peak times. According to Medicare, phones are busiest on Mondays and Tuesdays between 1 p.m. and 4 p.m. Also, it's far busier in the final days of open enrollment following Thanksgiving than it is now.Medicare can't tell you what plan is best, but it can provide you with useful information about your options.

If you're going to call, visit myMedicare.gov online to view helpful information, or use the Medicare Plan Finder tool. Here are a couple of things to remember.

First,if someone is calling Medicare on your behalf, make sure you're on the line with them initially to provide authorization for them to speak on your behalf. Second, write a list of your doctors, prescriptions, and doses ahead of time. Doing so can save time and help make sure that you get a plan that's right for you.

Finally, if you want some local, free help, reach outto your State Health Insurance Assistance Program, or SHIP. These local offices are staffed by insurance experts who can help you navigate your choices.

3. Know your numbers

Medicare Advantage and Part D plans are offered by private insurers, not the government, and that means that premiums and healthcare coverage, including prescription drug coverage, can change every year.

In order to make sure that you're getting the best deal, it can help to go into your research knowing how much these plans will cost, on average, next year. In 2017, the average Medicare Advantage plan will charge beneficiaries a premium equal to $31.40, plus your normal Part B premium. The average part D prescription drug plan premium is $34 per month in 2017.

4. Questions to consider

It can be more expensive to focus on premium, rather than coverage. For that reason, make sure you evaluate your current healthcare needs, and then determine if the plans you're considering deliver enough value. Some questions to ask yourself as you consider plans include:

  • If you have or can have other types of health or prescription drug coverage, such as from an employer or union, will that plan work with, or be affected by, your Medicare choice?
  • What are the coinsurance, co-payments, deductibles, and out-of-pocket limits for each plan?
  • Are your doctors and healthcare providers participating in the plan? Do you need referrals?
  • What will your prescription drugs cost under each plan? Are your medicines covered under the plan's formulary, and are there any rules that apply to your specific prescriptions?
  • Do you plan on traveling, and if so, will you need supplemental coverage when you travel?

In particular, when evaluating your choices, plan carefully when it comes to medicines. Beneficiaries' cost sharing for prescription drugs varies depending on where insurers place drugs in their drug formulary. If medicines are placed in low tiers on the formulary, your cost sharing may be far less than if they're placed in high tiers. Because placement can vary widely from plan to plan, it's best not to make any assumptions regarding your prescription drug coverage.

5. Look to the stars

In a bid to make it simpler for beneficiaries to compare plans, Medicare created a scoring system that uses a one- to five-star scale. The scoring system measures a plan's quality of care, access to care, responsiveness, and beneficiary satisfaction, among other things, and a star score of five is highest.

You can view star scores when comparing plans online in Medicare's Plan Finder tool. Five-star plans will be marked with a gold star, and poorly scoring plans are identified with an icon. Medicare also rates part D prescription drug plans, and those scores are based on things like call center hold time, prescriptions fulfillment, and how plans handle denials.

Overall, Medicare star ratings aren't your only consideration, but the ratings can help you avoid a poor plan option. They also may help you limit your plan options to a more manageable number of choices.

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