| Thu, Oct 25, 2012 @ 09:00 AM

OEP Boot Camp: Review Your Current Coverage

Posted by Medicare Made Clear

OEP Bootcamp Review Medicare coverage The third in a 6-post series designed to help you make informed Medicare choices for 2013

The Medicare Open Enrollment Period will end on December 7. That leaves just over six weeks to decide if you want to change plans and to enroll.

Earlier posts in this series provided information and tools to help you understand your current health care needs and budget. This can help define the coverage you need. You can use the links at the end of this post to go back to earlier posts, if you need to.

Once you know what you need your coverage to do for you, you’re ready to review the coverage you have now. The question you need to answer is: Does my current Medicare coverage fit with my health care needs and budget for 2013?

Begin With Benefits

You may have traditional Original Medicare or a private Medicare Advantage plan. Medicare sets the minimum standard for the benefits that both must provide. Beyond the standard benefits, these two ways of getting Medicare coverage have some significant differences. In addition, the total benefit package of one Medicare Advantage plan can be very different from another.

It’s important to understand the benefits you currently have. You can start by learning what Medicare Parts A and B cover. The coverage provided by these two parts together defines the minimum standard Medicare benefits. Medicare.gov is a good place to learn about the parts of Medicare and what each covers.

If you get your coverage through traditional Original Medicare, then your benefits include all that Parts A and B cover. (You may also have a private prescription drug plan or Medicare supplement plan that provide additional coverage. We’ll discuss these in a later article.)

If you have a Medicare Advantage plan, then you have the benefits of Parts A and B and may have additional coverage. This might include dental, eye and hearing care, prescription drug coverage or other extras.

Remember to pay attention to any benefit changes for 2013. You will receive notifications of changes from Medicare or your plan. You can also find information at Medicare.gov or your plan site.

Now, how does your current coverage stack up against your health care needs?  Are you lacking benefits that you need, such as dental care? Do you have any benefits that you don’t use?

If you need help defining your needs, you may want to read the first article in this series, OEP Boot Camp: Assess Your Health Care Needs.

Keep Costs in Mind

Benefits are just one consideration when evaluating your current coverage. You have costs as well. You need to understand your cost-sharing terms and how much you may spend out-of-pocket. Then you need to look at how your expected costs fit into your budget.

Your Medicare costs may include premiums, deductibles, copays or coinsurance. Medicare Part B charges a premium. You pay this to Medicare whether you have Original Medicare or a private Medicare Advantage plan. Your Medicare Advantage plan may or may not charge an additional premium.

Original Medicare charges coinsurance for many services. Your coinsurance share is usually 20% of the Medicare-approved amount for the service. By contrast, Medicare Advantage plans often use copays as a method of cost sharing. For example, you may pay a flat $20 copay for a doctor visit. Both Original Medicare and Medicare Advantage may charge deductibles.

As with benefits, changes in plan costs can occur from year to year. Your plan materials will highlight any cost changes for 2013.

So, how do the costs for your current coverage compare to your health care budget?  Are you comfortable with the monthly premiums you need to pay? What impact might your cost-sharing responsibilities have on your budget?

If you need help understanding your health care budget, you may want to read the first article in this series, OEP Boot Camp: Consider Your Health Care Budget.

Now What?

The first three articles in this series focus on coverage and costs. But there is another important consideration—convenience. The next article in this series deals with provider choice and provider networks.

Open Enrollment is underway. You have from now until December 7 to change your Medicare coverage choices, if you choose. In addition to this blog series, you can get help from these resources:

  • Medicare.gov, where you can download a copy of Medicare & You 2013, search for plans and find other helpful information
  • Private health insurance company web sites for information about 2013 Medicare Advantage (Part C) and Medicare prescription drug (Part D) plans
  • The 2013 Annual Notice of Changes mailed to you from your Medicare Part C or Part D plan, if you’re currently enrolled in one
  • A licensed health insurance agent in your community who can discuss all your plan choices with you

Be sure to report back to OEP Boot Camp for our next topic, Look at Your Provider Network. Our goal is to help you make informed choices during Open Enrollment.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.


Review Your Current Medicare Coverage: Asking yourself these questions may help you decide whether you want to change your coverage choices.

Medicare.gov: Visit the official U.S. government site for Medicare.

Medicare Choices Worksheet: Download a worksheet to help match your needs to coverage choices.

Read other posts in this series:



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