Seniors get lots of perks. There are all those nifty senior discounts at restaurants, retail stores, and movie theaters. You have the time and flexibility to take advantage of last-minute and off-season travel deals. And you also get Medicare.
Medicare gets a bad rap from younger people, but seniors love their Medicare coverage. The latest satisfaction survey shows between 80% and 90% of seniors are very happy with their Medicare plan.
Medicare provides great health coverage, but if you don’t understand your benefits or know how the program works, you might be missing out. Here are top tips to make sure you’re getting the best value from your Texas Medicare plan.
Learn the difference between Original Medicare and Medicare Advantage
You can get your Medicare benefits in one of two ways: Original Medicare (Part A and Part B) or Medicare Advantage. Many people believe they’re giving up benefits because Medicare Advantage is private health insurance, but nothing could be further from the truth.
By law, Medicare Advantage plans must offer the same coverage—at a minimum—as Part A and Part B. If it’s covered by Original Medicare, it’s covered by Medicare Advantage. But here’s the real advantage in Medicare Advantage: You usually get additional benefits you can’t get with Original Medicare.
For example, nearly all Medicare Advantage plans include Part D prescription drug coverage, so you get all your Medicare coverage in one convenient plan. Most also include dental and vision coverage, as well. Depending on the plan you choose, you may also get an allowance for over-the-counter medications and devices, free or discounted gym memberships, expanded home health benefits for meal delivery and housekeeping help, and access to a 24-hour nurse hotline.
Even better, there is a cap on out-of-pocket expenses with Medicare Advantage, so you can better plan for your health care costs. Talk to a Texas Medicare broker to find out what’s available in your area; you might be pleasantly surprised.
Take advantage of free screenings and preventive care
Medicare covers many routine cancer screenings and tests at no cost to you, so there’s no reason not to stay on top of medically recommended tests. Abdominal aortic aneurysm screening, bone density tests, heart disease screening and risk reduction, mammograms, cervical, colon, lung, and prostate cancer screening, and glaucoma tests are just a few things Medicare covers at 100%. Flu, pneumonia, and hepatitis vaccines are also free if your provider accepts assignment.
Take advantage of your free “Welcome to Medicare” visit and your annual wellness visit to talk to your doctor about preventive care, health screenings, and tests you might need each year—and schedule an appointment for those services. Remember the old adage: An ounce of prevention is worth a pound of cure.
Price-shop your coverage every year
You can make changes to your Medicare coverage each fall during the Annual Election Period, which runs from October 15 through December 7. During the AEP, you can add, drop, or switch Part D prescription drug coverage, enroll in Medicare Advantage, drop Medicare Advantage and switch to Original Medicare (or vice versa) and switch between Medicare Advantage plans.
During the Medicare Advantage Open Enrollment Period (January 1 through March 31), you can switch from one Medicare Advantage plan to another, or drop Medicare Advantage and return to Original Medicare and a Part D prescription drug plan.
Check out the plans available in your area and compare them to the coverage you currently have. Premiums and plan options change all the time, so you may be able to get better, more affordable coverage—but you won’t know if you don’t comparison shop.
Save on prescription medications
If you take prescription drugs on a daily basis, you could probably save a lot of money by switching to a mail order pharmacy approved by your plan. Most plans offer lower copayments—or even waive copayments entirely—if you fill your prescriptions through their mail order pharmacy. As an added bonus, you save on all those trips to the pharmacy.
If you’re currently taking brand-name medications, talk to your doctor about generic alternatives. Most plans use a tiered formulary, which means drugs in the lower tiers cost less out-of-pocket than those in higher tiers. If there’s no generic equivalent, ask your doctor if a lower-tier medication might work for you.
Did you know you can also use the prescription drug app GoodRx even if you have a Medicare plan? In some cases, the GoodRx price is lower than your copayment for certain prescription medications, and it costs you nothing to download and use the app.
Don’t be afraid to appeal a Texas Medicare plan decision
Whether you have Original Medicare or Medicare Advantage, you have the right to request an appeal or an exception to a coverage decision. If Medicare denies a certain service or your prescription drug plan won’t cover your medication, ask your doctor to help you appeal.
In many cases, if your doctor can show that a service or medication is medically necessary, Medicare will reverse its decision and pay for it. Your plan’s denial of coverage isn’t always the last word when it comes to your health care. You, your doctor, and/or your authorized representative can advocate for the care you need, and if necessary, you can escalate your claim to a hearing before a judge.
Medicare is a terrific program for seniors, especially if you take advantage of everything it offers. If you’re interested in learning more about plan options in your area and how to save on Medicare, talk to a licensed Texas Medicare broker.