6 Ways to Make the Most of Your Medicare Coverage

Medicare coverage is an essential part of retirement. It’s also one of the most confusing aspects of retirement planning. Before you dive into your golden years, it’s helpful to understand how Medicare coverage works and how much it costs.

The easiest way to do that is to get a Medicare advisor on your side. The agents at Local Medicare Specialists will answer all your Medicare questions and make sure you know how to get the most out of your Medicare coverage. We’ll start today by giving you six ways to make the most of your benefits.

1. Understand Your Medicare Options

Medicare does have a steep learning curve, but once you get familiar with your coverage options, it’ll seem much less complicated. You might get flooded with lots of conflicting information, so it’s best to work with an advisor you trust and spend some time doing your own research. Let’s run through a brief introduction to your Medicare coverage options.

Original Medicare

If you keep Original Medicare, your medical benefits will come straight from the federal government. Original Medicare includes Part A and Part B. 

Part A provides hospital or inpatient coverage. Most beneficiaries won’t pay a premium for Part A as long as they have paid taxes for 10 years. Part B provides outpatient medical benefits. The Centers for Medicare and Medicaid Services (CMS) sets a standard premium for Part B each year. Individuals with higher incomes could pay more than the standard premium.

Both Part A and Part B have other costs associated with them. You’ll be responsible for deductibles, copays, and coinsurance costs.

Prescription Drug Coverage

Original Medicare does not cover most prescription drugs, like the ones you get at your local pharmacy. Instead, you’ll need to enroll in Medicare Part D. Part D plans are sold by private insurance carriers, and each plan is different. You’ll choose the plan that offers you the best benefits based on your current medications.

Medicare Supplement Plans

Medicare Supplement plans are also called Medigap plans. They help “supplement” or fill in the “gaps” in Original Medicare. That does not mean they’ll pay for things that Original Medicare doesn’t cover. In fact, they’ll only cover services that are included in either Part A or Part B. 

What Medigap plans do offer is coverage for the out-of-pocket costs that you’d have to pay if you had Original Medicare alone. There are about 10 Medigap plans to choose from, but the most popular plans are Plans F, G, and N.

Medicare Advantage

Medicare Advantage is also called Medicare Part C. Medicare Advantage plans are separate from Original Medicare. If you enroll in one of these plans, you’ll no longer get your benefits from the federal government. Instead, your coverage will come from the private insurance carrier that sells you the Medicare Advantage plan. Each Part C plan must offer at least as much coverage as Original Medicare, and most offer extra benefits.

Medicare Advantage plans work very differently than Original Medicare, and there are many plans to choose from, depending on your ZIP code. Before you decide if this option is right for you, discuss the pros and cons with your advisor at Local Medicare Specialists.

2. Understand Your Plan’s Benefits

Once you’ve decided which Medicare plan is best for you, you should take some time to understand the ins and outs of how your coverage works. This will help you take advantage of all the benefits available to you and ensure you get the most out of your coverage.

The two main things you’ll need to know are where you can use your plan and which services are covered. For example, if you have Original Medicare (with or without a Medigap plan), you can see any provider that accepts Medicare. That will be pretty simple, as about 93% of healthcare providers in the United States accept Medicare.

On the other hand, if you have a Medicare Advantage plan, you’ll need to choose a doctor who participates in that plan. You won’t have as many providers to choose from, which is one of the trade-offs of having a plan with extra benefits and lower premiums.

3. Know Important Enrollment Dates

Enrollment dates are very important when it comes to health insurance, and it’s no different with Medicare coverage. Even once you’re enrolled, you’ll still need to mark your calendars to have your plans reviewed each year. If you miss an enrollment deadline, you could go without coverage or be stuck with a plan that doesn’t meet your needs. We’ll go through the most important enrollment periods here.

Initial Enrollment Period (IEP)

Your Initial Enrollment Period is the first opportunity you have to enroll in Medicare. It is a 7-month window that begins three full months before your 65th birthday month. It ends three full months after your birthday month. During this time, you can enroll in Original Medicare, as well as any other Medicare plans you’d like.

Medigap Open Enrollment Period

Each Medicare beneficiary has a one-time, 6-month open enrollment period for Medigap plans, which begins on your Part B effective date. During those six months, you can enroll in any Medigap plan you want, regardless of your current or past health conditions. After your open enrollment period ends, you will be subject to medical underwriting and are not guaranteed acceptance into a Medigap plan. (Some states have less strict rules, so ask your Medicare advisor about rules specific to your state.)

General Enrollment Period (GEP)

The GEP is for anyone who missed their IEP. It runs from January 1 through March 31 of each year. If you enroll in Original Medicare during this time, your coverage will begin on the first day of the following month that you enrolled. It is very likely that if you enroll during the GEP, you’ll be paying some late-enrollment penalties.

Annual Election Period (AEP)

AEP is the busiest time of year for both Medicare beneficiaries and Medicare advisors. AEP begins on October 15 and ends on December 7. This enrollment period allows you to review your Part C or Part D plans and make a change to your plan for the following year. It’s important not to ignore AEP because most Part C and Part D plans will change their benefits from one year to the next. Those changes could negatively impact your coverage. 

4. Take Advantage of Preventive Care

The best medical care is no medical care! We can’t always prevent health conditions from happening, but we can take measures to make sure we stay as healthy as possible. Medicare offers a host of preventive care benefits to keep you healthy and catch issues before they become bigger problems.

To start, you will be eligible for a “Welcome to Medicare” doctor’s visit. Along with this initial visit. You’ll have access to many other preventive services and vaccinations completely covered by Medicare. Be sure to take advantage of these services to stay healthy!

5. Budget for Healthcare Costs

Regardless of which Medicare plan you choose, there will always be a cost. You’ll have monthly premiums, as well as out-of-pocket costs, when you receive services. Sometimes, those costs can be surprising, especially if you aren’t prepared for them.

There is no right or wrong answer when it comes to choosing which type of Medicare coverage. As long as you know how your plan works and understand how it will impact your budget, you can anticipate most of your healthcare costs. Your Medicare advisor will help you plan for costs throughout the year.

Be sure to ask about other costs that Medicare plans don’t cover. You may need to look at long-term care insurance, cancer insurance, or a policy for dental, vision, and hearing care. Again, working with a local insurance agent in Arizona will ensure you piece together the health insurance portfolio that meets your needs.

6. Save on Prescription Drugs

For many beneficiaries, prescription drugs end up being the most expensive part of Medicare. Part D plans are often difficult to understand as there are several coverage phases. Your cost will be dictated by which coverage phase you’re in when you refill a prescription.

To save on prescription costs, follow a few of our tips.

Go Generic: If you are on name-brand prescriptions, ask your doctor about switching to a generic alternative. Generics are often much cheaper and will work the same way as your name-brand version.

Check the Formulary: A drug formulary is the list of prescriptions covered by your plan, organized by tier. Drugs that fall into higher tiers are more expensive than those that fall in lower tiers. Remember, each plan is different, so your prescription will not always be in the same tier across different plans.

Shop Pharmacies: Prescription drug plans also use networks. Pharmacies can either be preferred, standard, or out-of-network. Be sure you’re using a preferred pharmacy. You may also find pharmacies offer discount drug plans, which could offer lower prices than your Part D plan.

Don’t Skip AEP: We can’t stress how important AEP is. Even if you end up keeping your current plan, it’s well worth the few minutes it takes to review your medications and plan options. New plans are introduced into the market every year, so it’s likely you’ll find you can save by switching plans.

Shop Medicare Coverage with Local Medicare Specialists

Whether you won’t enroll in Medicare for another year or if you’re a seasoned beneficiary, you can get Medicare help from Local Medicare Specialists. We have Medicare advisors in your area with the expertise you need to make informed decisions about your Medicare coverage.

Don’t try to wade through all your options alone. Get an advisor on your side so you can make the most of your Medicare plans - and your retirement!