SeniorTruth

Since Medicare’s open-enrollment window runs from November 15 to December 31, it’s time to decide to keep, switch or modify your current Medicare plan. Be sure you understand any new options for covered services and evaluate their pros and cons.  Here’s a quick review:

Traditional or Original Medicare includes Parts A and B. Part A provides basic coverage for hospital care, while Part B covers doctor visits, other outpatient services and various medical supplies. Part A requires decreasing deductibles for the first 150 days of hospitalization, while Part B pays 80 percent of what Medicare defines as acceptable charges for approved treatment services.

Traditional Medicare will not cover eyeglasses, dental care, hearing aides, routine checkups or prescription drugs.

Medicare Advantage or MA plans allow you to enroll in identified HMOs and PPOs. Although MA plans are similar to traditional Medicare, they can limit your choice of doctors and hospitals to their networks. There are currently 66 MA plans from which to choose in Los Angeles County alone.

In addition to basic services, different MA plans may include coverage for eye exams, dental care, hearing aids, and prescription drugs. Although basic MA plan premiums are equal to those charged by traditional Medicare, other MA plans that cover additional services may cost a lot more.

To understand actual covered services and resulting costs, carefully review and compare available MA plans.

Medicare Prescription Drug Plan or Part D allows you to purchase prescription drug coverage from Medicare-approved insurance providers. It is available to, and usually purchased by,  those insured by traditional Medicare, since most MA plans do cover particular prescription drugs.  Part D includes an additional co-payment and deductible.

Remember, Part D does not cover all prescriptions. Different providers limit coverage not only to identified drugs, but also to approved dosages.

Many private insurers offer Medigap as a supplemental coverage to Medicare recipients. It often covers Medicare’s deductibles and particular out-of-pocket expenses but cannot duplicate Medicare’s covered reimbursements.

California offers 13 different types of Medigap policies, categorized from A through L. Depending on your policy, your coverage could include skilled nursing home care, at-home recovery or preventive care.

Before enrolling in the coming-year’s plan, make sure you carefully review the “Annual Notice of Change” that you should receive by mail  in late October.  It will include details about how your current plan may soon change – both in terms of covered services and higher costs.

To identify the Medicare coverage and plan that will best meet your needs, visit the Medicare website at Medicare.gov and click the blue button stating: “Compare Health Plans and Medigap Policies in Your Area.”

To obtain a free comparison of Medicare options that best reflect your particular needs, contact California’s Health Insurance Counseling & Advocacy Program (HICAP) at: 800-434-0222 or, from Los Angeles County, the Center for Healthcare Rights at 800-824-0780.