It's time to look at your Medicare plan

It’s that time of year to weatherize your house, your car—and your Medicare plan.

If you’re 65 years of age or older, and there’s been a change in the last year to your health, the prescription drugs you take or your financial status, now’s the time to give yourself a health plan checkup.

Start by asking yourself these questions about your Medicare Supplement or Medicare Advantage plan:


  • Are my drugs, including any new prescriptions, covered?
  • Do I know what my plan covers?
  • Is my plan changing for next year?
  • What were my out-of-pocket costs this year?
  • Does my coverage travel with me?
  • Am I planning anything in the near future that needs to be considered, like moving to a new state or having surgery?
  • Are my doctors still in the provider network covered by my plan?
  • Am I taking advantage of all the benefits my plan has to offer? This includes preventive benefits, like an annual exam, that may be available to you at no cost.) What other value-add benefits are available to me under my health plan, such as vision exams and gym memberships?

If you answered “no” or “I’m not sure” to any of these questions, you might want to review your health care coverage more closely.  Read the Medicare information your insurance company sent you. If you don’t understand it, reach out and contact your plan directly.

Medicare offers valuable information on their website, medicare.gov, too.

The State of Nebraska’s Senior Health Insurance Information Program (SHIIP) provides free education and advice about Medicare coverage options. The staff does not sell insurance. Call 1.800.234.7199.

It can be overwhelming to navigate Medicare, Medicare Supplement, Medicare Advantage and Medicare Part D drug coverage. Sometimes it’s just good to talk to a family member, a friend or a trusted advisor to learn what would work best for you.

There’s nothing like being confident your house and car are ready for winter.  The same is true for your Medicare coverage. Your health plan checkup may minimize any surprises about your benefits down the road and help you make a more informed decision.



HEALTH INSURANCE TERMS


COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy


in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.