Tis the season for Medicare enrollment

By WV Senior Legal Aid

Commercials and information are everywhere we look.

It can be confusing because there are many choices to make:  Medicare or Medicare Advantage, which coverage plan with what premium, deductible and co-pay amounts, which drug coverage option, which insurance company?

Medicare is handled by the federal government through the Center for Medicare and Medicaid Services (CMS).

Many don’t realize that Medicare Advantage (MA) plans are private insurance alternatives based on Medicare requirements. That’s not always made clear in the information.

You can enroll in one or the other, but not in both, for the same coverage period.

Under Medicare, there is coverage for hospital care (Part A) and for out-patient services (Part B). Prescription medications are covered under Part D (available through private insurance companies). Also, the customer can purchase supplemental coverage called Medigap from private insurance companies to cover portions of the amounts not paid by Part A or Part B. 

With Medicare Advantage plans, the minimum coverage requirements are set by Medicare. Premiums for hospital, physicians, out-patient care, and medication expenses are paid to the private insurance company. It’s one-stop shopping because one company can provide all of the coverages.

When authorized by the customer, Medicare or MA premium amounts can be deducted from their Social Security benefits.

The Medicare Open Enrollment Period, for coverage during the following calendar year, ends on December 7 every year. It is the only time when you can switch Medicare coverage plans or enroll in MA.

For those already enrolled in a MA plan, the Medicare Advantage Plan Open Enrollment Period from January 1 through March 31 is an opportunity to make one change to a different MA plan or to switch back to traditional Medicare.

One of the major differences between Medicare and MA is what doctors and hospitals a person may use.

The great majority of doctors and hospitals around the country provide care to Medicare patients.

MA plans are more restrictive by having only specified doctors and hospitals available to their customers.

If you choose a MA plan based on your favorite doctors, be aware that there is no guarantee those healthcare providers will remain in a given MA plan. They are permitted to withdraw at any point.

Under MA, “out-of-network” charges apply when doctors and hospitals not on the approved list are used. 

Another difference is overall cost.

The lower amounts for MA plans’ premiums, annual deductible, and service co-pays are based on more limited choices for healthcare providers than with Medicare. These upfront savings can be attractive when a person confirms that the healthcare options offered under a plan will suit their needs.

For actual bills paid for routine services and unexpected costs, neither Medicare nor MA consistently covers more than the other. As a result, the total amount the customer will pay during the year is not possible to evaluate accurately in advance.

Also, coverage for vision, dental and hearing services are often included in MA plans. Some also offer fitness programs, medical visit transportation, over-the-counter drug discount cards, in-home meals after a hospital visit, and other benefits.

Coverage for emergency care at any location in the United States is authorized under Medicare and MA.

For 2022, various factors, including the potential use of the new Alzheimer’s drug with a $56,000 annual cost per patient, will increase the Part B premium by almost $22 per month.

For help with problems related to Medicare or Medicare Advantage coverage issues, any West Virginia resident age 60 or over can contact West Virginia Senior Legal Aid at (800) 229-5068.