RBC I If you are eligible for Medicare, you should start exploring your options before you need to select coverage. Many Medicare medical and prescription drug coverage options are available for comparison shopping.
There is much to compare, particularly for health plans offered through private health insurers, called Medicare Advantage (MA). These plans often offer additional benefits—like dental and vision coverage—as well as things like gym memberships, online doctor visits and care coordination for people with certain chronic conditions.
“Premiums and benefits are different depending on the plan, so it’s important for people to look at these differences to make sure their plans meet their needs,” says Josh Martin with Anthem Blue Cross Blue Shield, which serves many MA members.
According to Martin, here are the basics when it comes to comparison shopping for Medicare coverage:
• Examine the plan’s list of covered drugs. Different plans have different lists of covered drugs, called formularies. Check to see if your drugs are covered and at what cost, particularly if you’ve gotten new prescriptions since you last picked your health insurance plan. The drug coverage in Medicare—called Part D—now includes more coverage for those with a “coverage gap,” and supplemental gap coverage is available in some plans. The coverage gap is a temporary limit on what Part D plans cover for prescription drugs. The gap starts after both member and plan have paid a certain amount for covered drugs. And different plans offer different benefits. For example, in most of its plans, Anthem Blue Cross Blue Shield offers drugs at a lower cost to those who use a pharmacy network that Anthem Blue Cross Blue Shield recommends because of its specially negotiated, lower-drug costs;
• Review the provider network. Are your favorite hospitals, doctors and pharmacies included in the network of your Medicare Advantage plan? You should check, especially since, in some plans, costs generally increase when you go outside the network. And in other plans, to receive coverage you need to stick solely with providers in that plan’s network;
• Consider the extra costs. When making your decision, weigh not only the plan’s monthly premium, but other out-of-pocket costs, like copays, coinsurance and annual out-of-pocket maximums;
• Look for bells and whistles. One of the pluses for Medicare Advantage plans is the extras, such as gym memberships, nurse health lines, online doctor visits, dental and vision coverage, and care coordination for people with certain chronic conditions. Compare plans to see what they offer;
• Explore the possibility of extra help. Those with limited income may qualify for financial assistance. Ask your plan for more information.
Additionally, you can visit www.socialsecurity.gov/extrahelp or call the Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778) for details.
To learn more, visit www.Medicare.gov. You can also contact individual plans like Anthem Blue Cross Blue Shield at anthem.com/shop or 888-900-4537 to learn about Medicare Advantage and other options, including Medicare Supplement and Part D prescription drug plans.
Those needing help choosing a plan may contact a State Health Insurance Assistance Programs counselor by visiting shipnpr.shiptalk.org/ shipprofile.aspx.
Anthem is a PPO plan, an HMO plan and a PDP with a Medicare contract. Enrollment in Anthem depends on contract renewal. For more information, contact the plan.
Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on Jan. 1 of each year. You must continue to pay your Medicare Part B premium.
This plan is available to anyone who has medical assistance from the state and Medicare. Premiums, co-pays, co-insurance and deductibles may vary, based on the level of extra help you receive.
Please contact the plan for further details.