5 Tips for Optimizing Your Health Coverage for 2021

For three months before and after your 65th birthday, you have the opportunity to learn your options and sign up for Medicare as your health insurance. Medicare is a monumental perk for that milestone birthday, but plans and coverage are likely to change from year to year after you sign on.

The plan that worked for someone on Medicare this year could be changing for 2021. For this reason, Medicare designates a specific time period every year called Open Enrollment during which an individual can review coverage and make changes if necessary. Here are some basics, along with important things to remember about getting the most out of Open Enrollment.

5 Tips for Medicare Open Enrollment for 2021

1. Don’t bury your head in the sand. Whether you’re happy with your coverage or not, it’s important to look at this anyway! In fact, your existing providers already may have tried to notify you by email or postal mail of changes for 2021. Don’t ignore these notices or let them stay buried in stacks of political solicitations from the elections. Dig them out, read them, and find out if the changes affect you personally.  Plan premiums as well as copays for drugs can change dramatically, and the last thing you want are bad surprises when it comes time to pay in 2021.
2. Ask questions and get help. You may think you can figure this out on your own, but you’re better off enlisting the help of someone who is trained to know.
   • The easiest way to get help is through SHIP, which is the State Health Insurance Assistance Program. Every state offers this program, and it’s free, one-on-one counseling for anyone who qualifies for Medicare. CICOA has several SHIP counselors who can help. Simply call 317-803-6131 to arrange to speak to a certified counselor or learn more here. Counselors can answer questions about coverage, premiums and the various plans you may qualify for. Again, this is a free service.
   • Fee-based consultants also can help. If you choose to work with a consultant, be sure they do not have a tie to a specific insurance company. Insurance brokers also represent health insurance. While their advice is free, brokers get a commission from the insurance company.
3. Know the lingo. There’s a lot of information that you’re going to see, so it’s good to know the basics.
   • Medicare Part A is the basic plan, but it covers only inpatient hospital care or a limited amount of time in a skilled nursing facility. (It doesn’t pay for doctor visits, prescriptions, medical procedures or even flu shots, for example.)
   • Medicare Part B is the equivalent of medical insurance, which helps pay for doctor appointments, outpatient care, home health care, medical equipment and some preventive services. Medicare Part A and Part B are administered through the federal government, and the Medigap policy you choose (from the private sector) serves to supplement these.
   • Medigap policies—also known as supplemental policies—help to pay Medicare out-of-pocket copayments, coinsurance and deductible expenses.
   • Medicare Part D is the prescription drug coverage plan, also offered as a supplement from private insurance companies.
   • Medicare Advantage Plan used to be known as Medicare Part C. You will need Parts A and B to get an Advantage plan, but you won’t need a Medigap supplement. The Advantage plans cover prescription drugs and additional benefits such as vision, hearing and dental. They are offered through private insurance companies, and there are an estimated 3,400 plans available across the country.
4. Consider ALL costs. Too often people select a plan based solely on the cost of the premium, which proves futile if it isn’t for the coverage that is needed. In addition to the obvious concern of premium cost, for example, make sure also to check the coverage of your medications (not just the copay but whether or not the drug is even covered). Also ask about any non-medical benefits—some plans offer services such as meal delivery, transportation to appointments and home modifications. Beginning in 2021, plans also will be able to offer benefits that target chronic health conditions. And COVID has made telehealth more popular, so more plans are offering coverage for visits over the phone for people who want that service.
5. Think ahead. If you know you may be having a knee replacement or other surgery in 2021, make sure your plan will cover not only the surgery and rehab, but also physical therapy. You’ll also want to make sure your plan allows you to choose the doctors you trust.

Open Enrollment extends from October 15 until December 7 every year so you can review your plan and make necessary or desired changes based on your needs. After doing your homework this time—if you see that no changes are necessary—you don’t have to do anything for another whole year!

The homework of review can be a little painful, but it isn’t nearly as distressing as failing to do so and getting surprised with higher costs or inadequate coverage. Acting during Open Enrollment to make the right decisions can save you thousands of dollars, improve your options for care when you need it, and give you peace of mind, year-round!

You can get more information at www.medicare.gov.