If You Are Medicare Eligible, Are You Medicare Educated?
Learning how to choose a plan for the best cost, health outcomes
Wednesday, September 25, 2019
by: Deborah Stone-Walls, n4a President

Section: n4a Blog




Medicare coverage is a wonderful benefit and an essential part of a healthy aging plan for all older adults. But picking the right Medicare option—coverage that works for you is just as important. As someone who works closely with older adults, I have seen older adults whose bank accounts were depleted because they picked the wrong Medicare coverage. I have met people who, unfortunately, selected the wrong plan to meet their health needs and suffered as a result.
 
It is hard to wade through the myriad Medicare plans and offerings, not to mention understand how the details of the coverage affect specific prescription medications and health care benefits. So, what should you do to learn about Medicare and the numerous options and offerings? How do you select the best plan to meet your health care needs, and then how should you best use those benefits? And, even more importantly, why bother? All good questions! 
 
Let’s start with the most important question: why bother?
 
Research shows that a patient’s adherence to their health plan is negatively affected by a lack of being informed. When people don’t take their medications or don’t attend a follow-up doctor’s appointment or test, they are considered non-compliant. Poor compliance is linked to increased Emergency Room visits and hospital stays, worse health outcomes and higher health costs (remember, deductibles are usually higher for ER visits than for an annual check-up!).
 
Hopefully, the thought of taking control of your health inspires you to learn about Medicare, and how to best use your benefits so you can maximize your health outcomes—and keep as much cash in your wallet as possible.
 
When and where to go for Medicare education and assistance?

 
If you are Medicare eligible, be ready for the upcoming Annual Open Enrollment period: October 15 and December 7, 2019. This is when you can select your 2020 Medicare benefits. This is your opportunity to seek out education and information to best understand you’re the choices you have for Medicare—and the benefits that are most helpful to manage your personal health needs. 
 
According to a recent survey commissioned by n4a and Anthem, Inc, and conducted by The Harris Poll, approximately half of older Americans surveyed (49 percent) said they have or would turn to a local aging organization, their State Health Insurance Assistance Program (many of which are operated by AAAs), or governmental resources for help when researching plans or options.
 
And those consumers would be right: the best places to seek information and most trusted resources are online at Medicare.gov, and in your local community through the Area Agency on Aging (AAA)—where you can meet one-on-one with a trained Medicare education or State Health Insurance Assistance Program counselors who can help you wade thru the various insurance options. (To find your local AAA, call the Eldercare Locator at 1-800-677-1116.) The AAA’s Medicare education programs are non-biased, trusted local resources that will help you understand your options and the plan features that may help you given your unique health care needs.
 
Selecting the right plan is a critical step to managing your health. Having the correct benefits in place will make managing your medications, your primary care visits and other treatments a better and more affordable experience.
 
How do you best use your benefits?
 
The Anthem-n4a survey also noted that 46 percent of older adults need help understanding their benefits after choosing a health care plan, and more than four in ten adults admit they would be better able to manage their health if they better understood their benefits. 
 
If you have questions before or after once you have enrolled in a plan, contact your local AAA so they can help explain your benefits to you. You should also check in with your insurance company to ask questions about your benefits and coverage. You may learn any number of important information about your Medicare plan—that a benefit included along with your Medicare plan is a gym membership, you may get to stay with your favorite doctor, or you may have lowered your co-pay—all because you took time to learn about the available Medicare plans before choosing one and then understood what benefits you have access to that. Taking these steps can improve your health and your overall health care experience.
 
As a AAA Director, I have seen first-hand the power of education in selecting the right Medicare plan, and witnessed the positive health and financial impact the having the right Medicare plan can have.  If you are eligible for Medicare, or a caregiver for someone who is, go online to Medicare.gov, find your local AAAs by calling (1-800-677-1116), and get educated for a better health care experience.
 
Once you have scheduled an appointment with your local Area Agency on Aging or State Health Insurance and Assistance Program, here’s a checklist of what you should bring with you:
  • Your Medicare Card
  • Knowledge of other health care plans you have access to. In other words, do you have retiree health care coverage from a past employer? If so, will Medicare be the secondary payer?  What does any other plan cover? What are the premiums? 
  • List of current medications you are taking. This will help compare plan formularies
  • List of your current physicians/specialists if you do NOT want to consider changing your doctors
  • Name of your preferred pharmacy
  • Income information to determine whether the cost of a plan might be a consideration
  • An idea of the number of visits to the doctor that you make in a month (or year). This will help determine whether the amount of co-pay for each plan should be considered in the overall affordability of each plan