It’s that time of year again. Medicare’s open enrollment season begins Oct. 15. During these 54 days, you will have the opportunity to make several changes. You can switch from Original Medicare to Medicare Advantage; you can shift from Medicare Advantage to Original Medicare; you can trade one Medicare Advantage policy for another; and you can buy a different Part D prescription drug plan.
Choosing among the various options and plans can be daunting. But a little bit of homework can reveal the many factors that can help shape your decisions. Think of Medicare as a buffet. You’ll want to pick the options that you can afford and that will meet your health needs. Here are some questions that can help point you to the best plan for you:
- Do you want to keep your doctors or are you open to changing?
- Do you have a preexisting condition?
- Are you taking medications regularly?
- Are you willing to change pharmacies?
- Do you expect to travel around the country or abroad?
- Do you plan to spend more time at your second home?
- Do you live in a rural area?
- Are you worried about what you can afford, from premiums to out-of-pocket expenses such as copays, coinsurance and deductibles?
- Are you eligible for Medicaid or other assistance programs?
- Do you have health insurance through your job or are you covered by your spouse’s plan?
- Are you insured through the Affordable Care Act individual marketplace, a retiree health plan, military plan or COBRA (the temporary coverage that people can buy when they leave a job)?
The answers to these questions can help you take stock of your current coverage, determine whether it falls short — or is just right — and pinpoint where you might want to make an adjustment or two. Our guide can help you navigate the Medicare landscape so that you can make the best choices for your health, your lifestyle and your pocketbook.
What Medicare Won’t Cover
It’s not unusual for people on Medicare to spend more than $5,000 a year of their own cash on ongoing health care and insurance costs. Then there are the needs Medicare does not cover. Here are additional costs you might face, and how to pay for them.
Opticians and eye exams
While Original Medicare does cover ophthalmological expenses such as cataract surgery, it doesn’t cover routine eye exams, glasses or contact lenses. Nor do any Medigap plans. Some Medicare Advantage plans cover routine vision care and glasses.
Solution: For some people, it makes sense to buy a vision insurance policy for a few hundred dollars a year, to defray the costs of glasses or contact lenses.
Medicare covers ear-related medical conditions, but Original Medicare and Medigap plans don’t pay for routine hearing tests or aids.
Solution: If you are in a Medicare Advantage plan, check your policy to see if it covers hearing-related needs. If it doesn’t, or if you have Original Medicare, consider buying insurance or a membership in a discount plan that helps cover the cost of hearing aids. Also, some programs help people with lower incomes get needed hearing support. Or you can pay as you go. Congress has passed legislation allowing some hearing aids to be sold without a prescription. The devices could be available in a few years.
Original Medicare and Medigap policies do not cover dental care such as routine checkups or big-ticket items, including dentures and root canals.
Solution: Some Medicare Advantage plans offer dental coverage, yours doesn’t, or if you opt for Original Medicare, consider buying an individual dental insurance plan or a dental discount plan.
Original Medicare and most Medicare Advantage plans offer virtually no coverage for medical costs incurred outside the U.S.
Solution: Some Medigap policies cover certain overseas medical costs. If you travel frequently, you might want a policy that offers this. In addition, some travel insurance policies provide basic health coverage; check the fine print. Finally, consider medevac insurance for your far-flung adventures. It’s a low-cost policy that will transport you to a nearby medical facility or back home in case of emergency.
Podiatry and cosmetic surgery
Medicare doesn’t generally cover routine medical care for your feet, such as callus removal. Nor does it cover elective cosmetic surgery, such as face-lifts or tummy tucks.
Solution: If you face these costs, you may want to set up a separate savings program for them.
Nursing home care
Medicare pays for limited stays in rehab facilities — for example, if you have a hip replacement and need inpatient physical therapy for several weeks. But if you become so frail or sick that you must move to an assisted living facility or nursing home, Medicare won’t cover your custodial costs. (Nursing homes average about $90,000 a year.)
Solution: Planning for nursing home care is a big issue, with lots of choices and decisions. But for those with limited income and savings, Medicaid might help fill in the gaps.
Medicare Advantage Expands Its Coverage
One of the big differences between Original Medicare and Medicare Advantage is that the latter’s 3,700 plans are able to offer several health care services and benefits that Original Medicare does not. Traditionally that has included coverage for dental, vision and hearing — even gym memberships in some cases.
There’s more to come. The Centers for Medicare and Medicare Services has recently given Medicare Advantage plans the go-ahead to provide an additional roster of benefits in 2019. These include products such as portable wheelchair ramps and “other assistive devices and modifications” that help people who have suffered falls, injuries or have other physical impairments. For example, a Medicare Advantage plan can pay for grips or portable chairs in a shower or modifications to homes, such as widening a door for wheelchair access.
Next year, about 270 Medicare Advantage plans will cover such benefits as adult day care services, in-home caregiving support, home-based palliative care and therapeutic massage.