October 15. The start of Open Enrollment comes at a busy time of year. Not only does this date mark the start of Medicare Open Enrollment (October 15 – December 7), but also the start of many public and private employers’ offerings with their own versions of Open Enrollment.
Medicare And You - Be Informed
This entire process seems to become more and more complicated every year. When you go onto the Medicare Website to learn a little about open enrollment, it recommends you review the 2021 “Medicare & You” handbook. For those of you not old enough (or lucky enough) to have been mailed the Medicare Handbook, let me tell you – it is comprehensive. This year’s book runs a total of 124 pages!
For those of you not in the healthcare/health insurance field, this can be intimidating. For HealthLink Advocates, it is a welcome piece of mail, received annually. Why? It is well organized, packed with information that is useful, and broken down with clear, concise explanations for anything you might need a little bit more information on.
What’s New This Year?
Let’s start with Page 2. (Page 1 is a title page with great, optimistic images) Page 2 gets down to business right away. This is where you would head if you wanted to know about any changes implemented from 2020 to 2021. Coronavirus tops the offerings, with a link to bring you directly to a page on Medicare.gov for any and all information you can imagine.
Also noted in “What’s New” this year:
Acupuncture (for chronic low back pain)
Telehealth benefits and “virtual check-ins”
An opportunity to shop/compare prices for pharmaceuticals
Information to help find and compare health providers (hospitals, doctors, etc.) including contact information and ratings
An efficient way to shop/compare healthcare plans
Changes in the coverage timeframe to sign up for Medicare Advantage if you have End-Stage Renal Disease.
Get The Most Out Of Medicare
Move further along in the handbook, and you will find clear explanations of Medicare and its options, Original Medicare vs. Medicare Advantage. There is even an area that speaks to how you can get “the most out of Medicare”. This is a good area to look into, as it outlines how one can maximize information that compares costs – something that we all care about. This year, with the addition of new expanded links to help compare providers and the costs involved with pharmaceuticals, makes for an outstanding read.
All of these “What’s New” offerings come with links that will bring one directly to a page that will expand on explanations for a better understanding of the options. The link brings you to a "bubble" page, where you can start the process by checking off the circle that you are interested in learning more about. These sites include information about Medicare Advantage, Drug Plans (Part D), as well as Medigap and Part D Drug plans within a Medigap policy.
Shop and Compare
With all of these links, the most important one to my mind would be a way to shop and compare healthcare plans.
Once you click on the option you are most interested in, computer-generated questions will bring you along to the different plan options in your zip code. The options discuss the monthly costs (premiums); copays, deductibles, and additional plan benefits. As you scroll through the different plans, you can isolate what benefits are most important for your particular situation.
As we all have health changes from year to year, the practice of reviewing your healthcare coverage every year is important. What you needed coverage for last year, may not be the same as what you will need this year. You have the opportunity to find a plan that best suits your medical needs – be proactive and make this review a yearly practice. Information is powerful, especially when it comes to your health and pocketbook.
After leaving that site, you can move on to similar “worksheets” for Prescription Drugs, as well and the other menu of plans offered through Medicare.
The book in itself is easy to read, with clear explanations and options for how to find additional information. I know that many will consider this to be “dry reading”, but take a stab at it. You might be surprised at the amount of information you will absorb.
Telehealth
In 2021, Telehealth through Medicare allows you access to “virtual check-ins”. These are brief, virtual visits about nonspecific medical conditions, or questions that you may have for your provider without needing a full visit. If you are on Original Medicare, these telehealth and virtual check-ins are offered without a co-payment. Those who have opted for Medical Advantage Plans should check with their plan to see what their options are, as each will be different. This situation may change as Covid-19 ebbs and flows through the year, but for right now, Medicare is on board with Telehealth services.
Note: If you are over 65 and did not receive that book, you are most probably enrolled in the “electronic version” through your Medicare account. That may be convenient (especially when clicking on the links), but you can go into your account and opt to have the hard copy sent out directly to your home if the hard copy is preferable to you.
Employer Health Plans Open Enrollment
Open Season for Medicare usually starts the onslaught of short-timed emails directing employees to sign-up for Employer-Sponsored Health Plans and updates on plan changes. A big change noted almost everywhere this year, are what the options for Telemed (also known as Telehealth) are. Some plans offer Telemed services through their own resources, others cite a co-pay or coinsurance for private Telemed services that you would select on your own – either your own physician or perhaps a local hospital offering.
Elsewhere in the HealthLink Advocates newsletter this month, you will see a narrative written by Lorie Gardner, who had a “first-time” experience with Telemed during her recent health journey. Lorie, a seasoned, trained, and experienced nurse, had no desire for unnecessary exposure while recovering from surgery, and decided to try out Telemed after suffering an injury at home. Lorie decided to utilize her Plan’s Telemed option. That was a lesson and chuckle for everyone, as the physician assigned to her case was not up to Lorie’s standard. The physician, according to Ms. Gardner was not effective in any way, misdiagnosing the severity of the injury (it was a burn), leaving her frustrated and on a roll. Lorie ended the call, vowing that it was a waste of time and will refuse to pay the bill - as no surprise – she knew more than he did!
There is a lesson here….look into your Telemed options now. Options should be laid out nicely within your new plan offering. Look at what the choices are. Does the plan offer a Telemed service on its own, where you call a plan published number and their physician handles the visit? Do you have the option of calling any Telemed service for treatment? If so, start looking for the best organizations (local hospitals and physician practices) that offer such services and keep the number handy. By far, the best option is to see if your own physician can be on your shortlist for Telemed. Not all insurances allow this, and not all physicians have this option scheduled into their practice, but it is worth a shot to make a call to your primary care physician and ask. It is time and funds well spent, if you can avoid a “factory Teledoc” and connect with your own physician – if that fails, yes. You can ALWAYS call Lorie Gardner. She knows more than most – and leaves you laughing while at it!