The response to Cassandra Valentini is typical this time of year when she asks groups during her Medicare outreach if they’re aware now is the time for annual enrollment.
It’s always, “how could you not know,” said Valentini, director of communications and community outreach for Direction Home of Eastern Ohio, a private nonprofit organization that offers support to older adults in the region, including help with Medicare.
That’s because, she said, those eligible for or already enrolled in Medicare are bombarded with everything from phone calls to mailers to television commercials advertising plans that sound fabulous, but can lead to confusion.
“It can all sound really, really great, and the reality is these formularies change every year, and the person, their needs change every year,” she said. “It’s a good thing they are able to make a change, obviously, because their needs change, but I think it makes it confusing because the formulary is always different.”
Picking the right Medicare plan — one that adequately covers a person’s health care needs and doesn’t cost an arm and a leg — can be a daunting task regardless if you’re about to turn 65 and new to the program or if you’ve been through the process already.
But not to worry, help is out there, whether from Direction Home, which has about 20 certified volunteers who provide outreach and help people navigate Medicare; the Ohio Senior Health Insurance Information Program (OSHIIP) within the state’s Department of Insurance; or from local insurance agents.
WHAT IS MEDICARE?
Medicare is federal health insurance for anyone 65 and older and for some people younger than 65 with certain disabilities or conditions.
There is Original Medicare and Medicare Advantage, which also is known as Part C.
The annual enrollment period, which this year goes to Dec. 7, is the time to change coverage for 2023. That could be switching from Original Medicare to an Advantage plan or from an Advantage plan to Original Medicare, or enroll in or change Medicare Part D prescription drug plans, according to personal finance company NerdWallet.
The effective date is Jan. 1.
If you have Medicare Advantage, NerdWallet says you also can use Medicare Advantage open enrollment from Jan. 1 to March 31 each year to switch plans or go back to Original Medicare and sign up for a Medicare Part D drug plan.
THE DIFFERENCES
There are some basic differences between Original Medicare and Medicare Advantage. According to medicare.gov, they are:
Original Medicare includes Part A and Part B.
Part A (hospital insurance) helps cover inpatient hospital, skilled nursing facility, hospice and home health care. Part B (medical insurance) helps cover doctor and health care provider services, outpatient care, home health care, some medical equipment like wheelchairs, walkers and hospital beds, and some preventative services like screenings, vaccines and yearly wellness visits.
However, it does not include prescription drug coverage. For that, people can join Part D, a separate plan for drug coverage. In addition, participants can buy supplemental coverage, like Medigap, or have coverage from a former employer, union or Medicaid to help pay out-of-pocket costs.
The plan allows users the freedom to use any doctor or hospital in the U.S. that takes Medicare.
Medicare Advantage is a bit different.
Rather than being managed by the federal government, Medicare Advantage is a Medicare-approved plan from a private insurer as an alternative to the original. Advantage plans include Parts A and B, and usually Part D.
The plans may have lower out-of-pocket costs than the original, but members must use doctors in the plan’s network. These plans may also offer benefits like vision, hearing and dental not covered by Original Medicare.
HELP
Direction Home, which serves Trumbull, Mahoning, Columbiana and Ashtabula counties, has partnered with OSHIIP to provide Medicare outreach and help in the four-county region. The agency has about 20 certified volunteers, including Valentini, who do the outreach, answer questions and help people navigate the system.
The organization also partners with places like the Ohio Living Senior Center in Youngstown, the Girard Multi-Generational Center and Country Neighbor in Orwell to also provide those services.
The goal is to help people find the right program, one that will cover the most and cost the least, Valentini said. Another part of the service to to help the person make the change, if needed, either online or over the phone with Medicare.
Direction Home volunteers and partners can also help people get enrolled in Medicare Part D’s Extra Help program, which helps costs associated with drug coverage, and the Medicare Savings Programs, which help pay for health care coverage.
“We run across so many individuals who don’t realize they qualify for these savings plans, and we’re able to help them fill out that paperwork, get them enrolled in those different plans and save them quite a bit of money,” Valentini said.
ADVICE
The best piece of advice, experts like Valentini and others say, is to compare plans during the enrollment period.
“Always at least check,” she said. “If you don’t know how to do it yourself, call us, because we’ll go through it with you and we’ll do it for free. At the end of the day, if you don’t want to change your plan, that’s fine, (but) don’t ever just not review it because the next thing you know, you’ll be getting a bill.”
Dominic Mararri owns Senior Care Insurance, an independent insurance agency in Warren. He represents several large health insurance companies.
“A lot of people assume they are on the best plan or the plan works for them, so they don’t want to try anything new. When you buy a car, you sit down and look at that car, you may discuss maintenance, you may discuss fuel mileage,” he said. “You sit down and and put some effort into buying that new car and, I would just like to encourage people who are in Medicare to put some effort into their insurance plan.”
“Every year, these plans change, so take an hour aside and look at the documents that are sent to you,” he said.
Mararri also recommends keeping an open mind to change, and, said Valentini, people shouldn’t pick a plan just because it sounds good.
Also, ask questions and reach out for help.
“If you need help, don’t hesitate to call and ask for us to have a look,” Valentini said. “You could either call us or either one of our partners or OSHIIP directly and somebody will help.”
“There all kinds of resources out there that will help you understand Medicare,” Marrari said.
rselak@tribtoday.com