Seven important questions about Medicare coverage

September 13, 2021

Next month, Medicare’s Annual Election Period (AEP) kicks off, starting on October 15. During this time, you can change your Medicare coverage or enroll in a Medicare Advantage (MA) plan. Whether you are new to Medicare or deciding to change plans during AEP, you owe it to yourself to see if the Medicare Supplement or Part D plan has you covered for all the extras or during an unexpected illness. This year, spend some time comparing your options.

We know that many of you will meet with a broker or a sales agent to help find the best coverage option to meet your needs. It’s a good idea to be prepared, and the Aspire Health Plan team wants to help you out! Here are a few less common, but important questions about Medicare coverage to ask your broker or sales agent.

1. What’s the maximum out-of-pocket I pay in a year if I was to get really sick?

Out-of-pocket costs mean the amount you pay for healthcare services, not counting a monthly premium, and a MOOP is a maximum out-of-pocket amount you’ll spend annually for healthcare costs. Remember that Original Medicare (Parts A and B) has no out-of-pocket limit. This means that there’s no limit on the amount you may have to spend. The more medical services you need, the more you’ll pay in Medicare costs. Only two MedSupp (Medigap) plans – Plan K and Plan L – have out-of-pocket limits. MA plans are required to stick an annual limit set by Medicare, known as the maximum out-of-pocket (MOOP) limit. However, some plans set their out-of-pocket limits below the MOOP. Do your best to anticipate how much care you’ll need during the year to help you decide if you prefer a plan that costs more upfront with lower out-of-pocket costs or a plan that costs less up front with the potential of incurring more out-of-pocket costs throughout the year.

2. Are there extra benefits such as telehealth, transportation, fitness, and chiropractic coverage?

Original Medicare and MedSupp (Medigap) policies do not offer supplemental benefits. MA plans cover everything that Original Medicare covers and more, including supplemental benefits which are extra benefits that can save you money and help you stay healthy. Keep in mind, supplement benefit offerings vary by plan, so take a look at each plan’s offerings in your area.

3. Do you have programs to keep me healthy or an advocate to help me navigate my healthcare?

Healthcare is about much more than just doctors’ appointments and prescription medication. Holistic health is about caring for the whole person. When looking at Medicare coverage options, see what plans offer in terms of health and wellness benefits. For example, Aspire Health Plan’s MA plans offer no-cost access to an enhanced care team including health coaches, care managers and social workers in addition to the Diabetes Prevention Program, a free 16-week series plus a year of monthly check-ups.

4. Will the plan cover me if I travel and get sick?

No matter what, it’s important to make sure your health insurance covers you while traveling. When traveling with Medicare, your healthcare coverage depends on where you travel (inside or outside the U.S.) and the type of Medicare coverage you have. (We go into this in more detail in a previous blog post.) If you are a frequent traveler, this is something to consider when shopping for Medicare coverage.

5. Are my prescription drugs available on the drug formulary?

Original Medicare does not cover prescription drug medications. Neither do MedSupp (Medigap) plans. This means that you must pay out-of-pocket for prescription drugs or enroll in a separate Medicare Part D prescription drug plan. Or, you can enroll in an MA plan with Part D coverage (MAPD). When reviewing Part D or MAPD plan options, look at the plan’s prescription drug formulary or “Drug list” a list of prescription drugs covered by the plan.

In the last year, If your prescription drug needs have changed and your out-of-pocket costs for prescriptions have increased, you may want to consider other plans that may better meet your needs. Make a list of prescription drugs that you currently taking to help compare costs.

6. Can I get dental, vision, and hearing benefits?

When it comes to these important benefits, remember that Original Medicare does not cover:

  • Routine dental care aka care you receive in a dentist’s office including cleanings, dentures, dental plates, fillings, tooth extractions, etc.
  • Routine vision care such as vision exams, eyeglasses (frames or lenses), or contact lenses
  • Hearing aids or exams for fitting hearing aids

The same applies for MedSupp (Medigap) policies. MA plans offer optional coverage that goes beyond Original Medicare including extra benefits (like dental, vision and hearing coverage) designed to save you money. Some plans offer this as an enhanced benefit and others include it in their core product. Coverage options vary by plan, so make sure you view MA plan options in your area to see what they offer.

7. Is there a local office where I can speak face-to-face with a customer service representative?

Customer service is always important. As a local Medicare Advantage plan, Aspire Health Plan is located right here in Monterey County. Unlike so many large, faceless insurance corporations, we are a local company made up of people who live right here in Monterey County. We have walk-in office hours 8 a.m. – 5 p.m. PT, Monday through Friday, and we are located at 10 Ragsdale Drive, Suite 101 in Monterey. We can also be reached easily over the phone. Call (855) 570-1600 for Member Services or call (866) 798-1530 for Sales. TTY users can call 711.

Remember, there’s more to consider than just premiums and co-pays — there’s knowing you are covered for the unexpected. As a Medicare Advantage plan sponsor, Aspire Health Plan offers Monterey County’s only Medicare Advantage plan.

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