Decisions, Decisions

What to Look for in Medicare, Medicare Advantage Plans

By Sarah Fernandes

Each year, people who are 65 or older make decisions about their Medicare and Medicare Advantage coverage during the Medicare Annual Enrollment Period (also known as Open Enrollment) from Oct. 15 to Dec. 7. Before choosing their plans, Medicare beneficiaries should consider a few things.

Is All Medicare Coverage the Same?

While Original Medicare (Parts A and B), the plan provided by the federal government, covers hospitalizations and most doctors’ services, coverage for other services — like outpatient care, medical supplies, and preventive health care (Parts C and D) — can vary widely. Part C, otherwise known as Medicare Advantage, and Part D (prescription drug coverage) are offered through private insurers, such as Health New England and others.

Sarah Fernandes

“By focusing on prevention, any potential health issues can be identified early, and you can work to maintain optimal health and prioritize your well-being.”

What Is Medicare Advantage (Part C)?

Medicare Advantage (Part C) plans cover everything Original Medicare (Parts A and B) would cover, but offer additional benefits and services beyond Original Medicare. These added benefits can include prescription drug coverage, vision care, dental services, hearing aids, wellness programs, and more. Medicare Advantage plans provide greater opportunities for beneficiaries to engage in preventive services, such as regular check-ups, screenings, vaccinations, and health education.

By focusing on prevention, any potential health issues can be identified early, and you can work to maintain optimal health and prioritize your well-being. If you do have a chronic condition, a coordinated approach from your Medicare Advantage plan and your providers ensures that you receive the necessary support, education, and interventions to manage your condition effectively, leading to improved quality of life and health outcomes.

How Do I Decide?

To decide what plan is right for you, be sure to review the features of the plan. For instance:

• Make a list of your preferred healthcare providers and see if they are considered in network or out of network for each plan you are considering. Some plans do not cover out-of-network services at all, while some cover them partially.

• Similarly, make a list of your medications and see if they will be covered and how much, if anything, you will need to pay out of pocket (your co-pay).

• If you travel or spend time in other areas of the country, check if the plan allows you to use any Medicare-accepting doctor anywhere in the U.S.

• See if the plan covers dental, vision care, hearing services, and prescription drugs.

• Ask if the plan offers additional healthy benefits such as gym memberships, coverage for acupuncture, activity trackers, and weight management programs.

How Do I Learn More?

Health New England’s Medicare Advantage plans are a popular option for people age 65 and older who are looking to tailor their healthcare coverage to their personal needs. Health New England has many high-quality providers in our network across Western Mass., and we have plans that cover you anywhere you travel in the U.S.

To learn more about choosing the right Medicare or Medicare Advantage plan, you can attend Health New England’s live information sessions, which you can find and register for at healthnewengland.org/medicare/sessions, or visit healthnewengland.org/medicare for details about all we offer. You can also call Health New England at (877) 443-3314 (TTY: 711).

Other resources include SHINE, Massachusetts’ free Medicare advice service; visit online at mass.gov/health-insurance-counseling or call (800) 243-4636. Meawhile, the Medicare website is medicare.gov. n

Sarah Fernandes is the Medicare sales manager at Health New England and been with Health New England for more than 25 years. She and her team spend countless hours educating Medicare beneficiaries in Western Mass. on their Medicare options.