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Tuesday, July 23, 2024

Using information to make the right decision

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(ARAcontent.com) — For many people, the focus during the months of November and December is on the holidays. The most important decisions they make involve where the family will gather, what to serve at the holiday dinner and finding the perfect gifts for friends and family members.

However, for individuals who are eligible for Medicare, the time between Nov. 15 and Dec. 31 presents an opportunity for another important decision — one that can have a longer-term impact than what dessert to serve, or which presents their grandchildren will like the best.

This month-and-a-half is known as the Open Enrollment period, when those eligible for Medicare have the opportunity to choose their Medicare plan for the upcoming year. During this time, more than 40 million individuals who are eligible for Medicare sort through a wide range of resources, including those offered by the Centers for Medicare and Medicaid services (www.medicare.gov), senior centers and community organizations and health insurers that offer Medicare Advantage plans.

“As people enter this age range, they often have an increased need for health care services, so it’s extremely important to choose a plan that will help protect their health and financial well-being,” says Frank McCauley, head of Aetna’s Consumer Business Segment.

The first step in choosing the right Medicare plan is understanding the different components of the program. While most people have heard of Medicare, they might not be aware that there are different categories of Medicare plans.

• Part A helps pay for inpatient hospital care, skilled nursing facilities, hospice care and some home health care. Because people usually pay for Part A coverage through a federal Medicare tax while working, most don’t pay a deductible or monthly premium after age 65.

• Part B helps cover doctors’ services, outpatient hospital care, and physical and occupational therapy. This is optional and usually requires a monthly premium.

• Part C includes Medicare Advantage plans (such as health maintenance organizations and preferred provider organizations) and provides Parts A and B benefits to enrollees, as well as prescription drug benefits in some cases. With these plans, Medicare contracts with private insurers to provide this coverage.

• Part D provides coverage specifically for prescription drug benefits. Like Part C, Medicare contracts with private insurers to provide this coverage.

• According to McCauley, Medicare Advantage plans offered by private insurers provide an “all-in-one” solution for consumers.

“These plans allow people to pay one monthly plan premium for a complete benefits package, and they can also be combined with Medicare prescription drug coverage, which is a significant plus for many retirees,” McCauley says.

In addition, many insurers offer “extra” benefits through their Medicare Advantage plans that go above and beyond the original Medicare plan, including:

• Disease management or case management programs, which can be particularly beneficial for individuals who have chronic conditions.

• Online tools such as Personal Health Records (PHRs), which allow members to store their medical information electronically and access it any place an Internet connection is available (as opposed to storing medical records in a file cabinet or shoe box).

•Discounts on health-related products and services that can be critical to Medicare beneficiaries, but might not be covered under the basic Medicare program, such as vision and hearing aid products and services, fitness programs and alternative health care programs.

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