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Tuesday, September 28, 2021

It is time to check Medicare coverage

Dr. Veita Bland / October 27, 2017

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Open enrollment began October 15 and ends December 15. Knowing one’s options may save money.

Open enrollment began October 15 and ends December 15. Knowing one’s options may save money.

The dates of October 15th through December 7th are critical to those who receive Medicare. This short 54 day window is when Medicare recipients must choose their Medicare plan for 2018. The decisions made during this short window of time will affect the quality of one’s medical care in 2018 and in years to come. The plan chosen can save or cost you money. It is imperative that much thought be given to this major decision.

The first decision to be made is if you want to enroll in Original Medicare or in one of the Medicare Advantage programs. Original Medicare has two parts. Medicare A will cover most of the cost related to hospital stays. Medicare B will cover your doctor visits, lab work, preventive care and outpatient services. Medicare A is free to those who qualify for Medicare. Medicare B comes with a cost. There are deductibles and copays involved with both parts. The average premium for Medicare B will be around $134.00 a month but that may go up depending on your income.
Medicare Part C is typically known as Medicare Advantage. Here, those who like being in health maintenance organizations (HMOs) or a preferred provider organization (PPOs) can continue in that frame. In Medicare Advantage you get your Medicare Part A and Part B covered by private insurance companies. These have networks of health care providers and you need to make sure your health care provider is within the network to avoid out of network fees. There are pros and cons to each plan. In Original Medicare there are more choices of healthcare providers, your plan is secure and will not shut down, no referrals are needed for specialists, premiums are set by the government and your coverage is national. The negative of this plan includes the monthly premiums maybe higher than in Medicare Part C, especially if you need supplemental insurance. Out of pocket cost could be higher if there is a serious illness as there is no out of pocket spending limit and the separate plans to cover medications such as Medicare Part D can add to the cost.

With Medicare Advantage or Medicare Part C the advantages would be that most plans cover drug and supplemental costs, some plans have dental, vision and hearing. There is a primary care physician coordinating your overall care and there is typically lower cost sharing. The cons to this plan would be paying more to see doctors out of network and needing referrals to specialists. Some plans may charge an additional premium above the standard Part B charge, and the plans are difficult to compare as no two are alike.

Supplemental insurance or Medigap covers most out of pocket expenses that Parts A and B do not, such as hospital deductibles, and the 20 percent doctor visit copay in Medicare B. You are guaranteed coverage during the initial enrollment period even if you have a preexisting condition and coverage is guaranteed renewable as long as you pay the premiums, the coverage is nationwide and the plans are standardized by the federal government making them easy to compare. The cons with these plans are that the average premium is more than $2000.00 a year, once enrolled it may not be easy to switch plans. If not signed up for during the initial enrollment period, plans can deny coverage or increase rates and there is no drug coverage so you will need to seek a Medicare part D plan for that.

The costs of medications were not originally covered in Medicare. In 2003 Congress created Medicare Part D. Here, prescriptions are covered this is especially important with Original Medicare A and B. There are different plans and the same medication may have very different copays. This is where you need to look and make sure that your medications are on the plan you choose and at the best cost to you. This is very important to review each year especially if your medication needs change as your health changes.

This is not easy so take the time to study the plans and get unbiased help, not from someone trying to sell you a plan. Seniors’ Health Insurance Information Program is located in most states. They are run by the state government and can help with information in your state. Give them a call at (855) 408-1212.


Dr. Veita Bland is a board certified Greensboro physician and hypertension specialist. Dr. Bland’s radio show, “It’s a Matter of Your Health,” can be heard live on Wednesdays, 5:30 p.m. on North Carolina A&T State University’s WNAA, 90.1 FM. Listeners may call in and ask questions. The show is replayed on Sirius 142 at 5 p.m. on Wednesdays. Email Dr. Bland at ideas@blandclinicpa.com.




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