Medicare enrollment period ends Dec. 7

With just a few weeks left to apply or make changes to for Medicare, there are a few things that they should know when making their decisions.

"Medicare applicants often find themselves overwhelmed with information when deciding which insurance plan works for them," said Pennsylvania Medicare Education and Decision Insight (PA MEDI) director Susan Neff. "The main question that we hear during the open enrollment period is, 'where can I go for help?'"

Fortunately, the state Department of Aging has a Medicare counseling service that helps folks shuffle through all of the different plans and choose the right one for them. PA MEDI is part of a nationwide network of State Health Insurance Assistance Programs (SHIP). The program provides unbiased, one-on-one counseling from specially trained counselors to help folks make educated decisions when choosing their insurance plan or making changes to their current plan.

Neff said PA MEDI serves as a place to go for help when trying to navigate the different health insurance coverage plans.

The local PA MEDI program for Huntingdon County operates out of the local Area Agency on Aging office and can be reached at (814) 643-5115.

"The other main question that folks seem to have is 'how does Medicare work?'," said Neff. "It's relatively straightforward. Medicare is health insurance specifically for folks who have recently turned 65 or are older than 65. Certain individuals under 65 who have a disability may also be eligible for health coverage."

There are two options to apply for coverage: original Medicare and Medicare Advantage.

"Most Medicare recipients will have original Medicare unless they apply for Medicare Advantage," said Neff. "Medicare generally includes Part A (hospital coverage) and Part B (medical coverage), but doesn't cover prescriptions unless added to the plan. Medicare Advantage often combines Part A, Part B and Part D (prescriptions) in a bundle."

Neff said that while the Medicare Advantage plans provide excellent health coverage for many people, they still have to consider the potential for prior authorizations and denial or denied provider payments if they don't have the right plan.

"Deciding on a Medicare Advantage plan is difficult," said Neff. "There are more than 60 plans to choose from. Medicare applicants need to compare each plan based on their needs. It's important to shop around and compare plans."

Most folks focus on the cost of a Medicare plan, said Neff. They consider how much they will have to pay each month (the premium payment) when there is so much more to look at.

Neff said that folks should be asking the right questions to narrow down the right choice for them. Some of these questions include: what are my personal healthcare needs? What are the plan copays and out-of-pocket expenses Are my preferred doctors/specialists/hospitals considered in-network? Am I covered if I travel nationally/internationally? Which medications are covered and can I continue going to my local pharmacy? What other services (physical rehabilitation, ambulance transportation) are covered? Are there any additional benefits and are they available in my area?

Current Medicare enrollees should have already received a plan annual notice of change in September. This notice informs folks of the changes deemed effective in January.

"In the annual notice, enrollees would've learned that the Medicare Part B premium will increase to $174.10, beginning Jan. 1," said Neff. "This is a $9 increase from last year. It's important that folks review these changes to determine if the plan will continue to meet their needs both medically and financially."

Neff reminded folks to never give out their personal information to avoid becoming the victim of fraud.

"Medicare beneficiaries need to protect their personal information when it comes to their health insurance," said Neff. "Never give your Medicare ID number or Social Security number to anyone who might call you, come to your door, or set up a table at a health fair or a grocery store claiming to offer free services. Most of these activities are fraudulent and come from scammers."

Neff said that the Department of Aging and PA MEDI will never ask for this information over a phone call or by coming to your home.

If someone thinks that they might've been the victim of fraud, they can call the PA Senior Medicare Patrol at 1-800-356-3606.

Folks have until Dec. 7 to apply for a Medicare plan or make changes to their current plans. Any changes to these plans will go into effect Jan. 1, 2024.