Medicare Annual Enrollment: The Path to Medicare Happiness

Medicare ranks among the most popular federal programs in the U.S. Most people on it like it. But not everyone who has it — some 25% according to surveys — fully understands it. The key to Medicare happiness depends on how much effort you put into learning about it.

One of the most important things to remember about Medicare is that you always have options. During the Annual Enrollment Period — happening right now through December 7 — you get to make changes in your coverage that take effect at the beginning of the next year. This means you can try a Medicare Advantage Plan or, if you're on one, change back to original Medicare. Or you can switch to another Medicare Advantage Plan. Or you can do nothing and the plan you currently have will renew automatically for another year.

The ABCs of Medicare

All these options, while good, can cause confusion, especially if you're listening to all those Medicare commercials flooding the airwaves. To get the most out of Medicare, the first thing you want to do is make sure you enroll in the right plan. The plan you chose affects how much you pay for coverage, what medical services you receive, the kind of doctors you use and the quality of care you get. Here is a simple rundown of the plans you can enroll in:

Part A (no cost) covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery and home health care.Part B (optional, you pay $170.10 each month or more) covers outpatient services, doctors, specialists, labs, medical equipment, X-rays, CT scans and usually drugs received at a doctor's office, hospital or infusion center.Part D (optional, you pay about $31.50 a month) helps cover the cost of most prescription drugs.Part C (optional, you pay $170.10 each month plus $0 to $200 extra), also called Medicare Advantage Plan, combines Part A, Part B and sometimes Part D coverage and is supplied by a private insurance company, usually with added benefits.

Important: If you refuse Parts B or D, you will pay a penalty if you later decide to take them.

With original Medicare, you can see any doctor who accepts Medicare patients. Most Medicare Advantage Plans are HMO, which limits your health care to network providers and may not provide coverage if you travel out of state or the country. However, some MA Plans offer PPO plans that charge copays for doctors outside the network.

MA Plans have out-of-pocket cost caps, but original Medicare does not. Instead you can purchase supplemental insurance called Medigap, which pays costs that Medicare doesn't cover. However, insurance companies can refuse to cover preexisting conditions if you ever want to switch from original Medicare to a Medicare Advantage Plan.

Medicare Advantage Deconstructed

Insurance companies that offer MA plans often pack them with tantalizing perks. Are they worth it? The Kaiser Foundation reports almost half of Medicare enrollees have switched to a Medicare Advantage Plan, and the number of enrollees keeps increasing each year.

Medicare Advantage Plans have become popular because they provide value-based care. This means network providers are expected to offer high-quality care, charge lower costs and keep you, the patient, happy. Prevention, instead of fee-for-service, is the goal. If chosen properly, Medicare Advantage Plans can accommodate most all of your health care needs. This often includes prescriptions plus perks like dental, vision, hearing, health club memberships and more.

The barrage of advertisements shows just how competitive Medicare Advantage Plans have become in Arizona. It's worth taking the time to parse the benefits they offer because a plan's value all depends if the plan meets your needs.

Medicare Matchmakers

The most difficult part of comparing plans is researching and comparing the list of medicines that each plan covers, so you want to do your homework if you have maintenance prescriptions. Each plan has its own list of covered prescription drugs, and drug prices differ among the plans. In other words, one plan may save you a bundle and another one cost more.

You have several ways to flush out a plan's details to determine which plan matches what's right for you. The official government website, Medicare.gov, provides detailed information about Medicare as well as the MA Plans offered by insurance companies. You can call each insurance company offering an MA Plan that looks compatible to your needs to make sure it makes the best fit for your needs.

If you want someone to help you, you can make an appointment (free, but available times go fast) with a Medicare expert at the Arizona State Health Insurance Program (https://des.az.gov/services/older-adults/medicare-assistance). Or you can consult with an independent agent that specializes in Medicare. Consulting with these agents/brokers does not cost you anything; the insurance company offering the plan you choose pays the agent for helping.

Whatever path you chose to reach Medicare happiness, just remember: You get to chose the path that's right for you, and you can always change it.