It is Medicare open enrollment time through December 7, to give you the opportunity to review and bring up to date your Medicare coverage.
Choices of coverage can be very confusing, and it is valuable to schedule an appointment with an experienced and trained Senior Health Insurance Program, or SHIP, counselor. SHIP counseling is offered through Senior Services Associates, and at other qualifying senior centers throughout the state. A SHIP counselor is a person who objectively counsels Medicare beneficiaries, and their caregivers, or representatives who have issues and/or questions regarding Medicare, Medicare supplement, Medicare managed care, or other insurance- related questions. They are trained and certified and operate through a SHIP sponsoring agency.
Ship counselors are background-checked, must provide health insurance counseling without conflict of interest. They cannot be affiliated with the insurance industry, or an insurance claims filing business, and cannot serve as a SHIP volunteer for personal and financial gain. SHIP counselors cannot recommend a specific insurance company, agency, or policy, and they must attend ongoing education classes.
Seniors who have sought SHIP counseling before, know to bring any and all medications, and health information with them for their SHIP appointment, so that they can choose the best insurance plan for their needs in the new year.
For those new to the system, it can be a confusing time. For those new to joining the ranks of 65-plus, there are some important milestones to accomplish first, including signing up for Medicare A & B within the seven-month window of their birthday, and then it is choosing how to manage the gap between what is covered by Medicare and what is not.
Now you have to choose whether to go with Medicare Supplemental insurance (Plan G), or to choose a Medicare Advantage plan (Plan C).
It is worth noting that insurance companies are highly-motivated to sell Medicare Advantage plans. These plans are funded directly through Medicare to the insurance company, with the insurance company paid directly for each beneficiary’s expected costs. The more enrollees, the more money the company receives from the government.
Medicare Advantage plans usually include vision and dental coverage. Without incurring a major illness, a Medical Advantage plan will be less expensive because there is usually no monthly premium. For someone with high medical costs, a Medicare Advantage plan works fine. For those who are less likely to travel, there is no worry because your doctor’s network is easily accessible.
Some disadvantages of Medicare Advantage Plans include being restricted in network and needing prior authorization for procedures. If an expensive illness does occur to someone with a Medicare Advantage Plan, they may end up paying thousands, while the Medicare Supplement Plan G plans limit the amount the patient will pay.
Medicare Plan G subscribers can see any doctor that accepts Medicare, and they can choose to see a specialist without a referral. Most Medicare Advantage Plans are similar to an HMO, but Medicare Advantage PPO plans also offer an option to see a specialist without referral. Medicare Plan G subscribers pay a small yearly deductible, just $226 in 2023, but Medicare Advantage subscribers can see multiple copays for services throughout the year.
How to make sense of it all? If you are healthy with less medical care, you may pay less with an advantage plan, while those with high use of medical care will save money on a Plan G. However, it is easy to move from Plan G to a Medicare Advantage Plan and much more difficult to move from a Medicare Advantage Plan to Plan G.
Wondering which choice is best for you?
A certified SHIP counselor can help you review your options. They can help you better understand Medicare out-of-pocket costs.
Lastly, remember, many health insurance companies will be sending invitations to your door. Make informed decisions and do not get swayed without consulting someone you trust.
Barb Nadeau is the Mobility & Community Relations Manager for Voluntary Action Center of Northern Illinois, representing five counties. Barb’s career includes many years as a professional television and radio host, as well as a print and social media journalist, and as a volunteer coordination professional, networking among non-profit social service agencies throughout Illinois. She is a freelance writer and an elected alderman in the City of Plano. Contact Barb at bvnadeau@gmail.com.