Medicare Options: Pick what fits, but deadline is Thursday midnight

Dec. 4—You may be tired of all the TV ads and mail flyers, but don't let that keep you from considering your Medicare coverage options as the Dec. 7 deadline approaches, a director in Highmark Health's Senior Markets cautioned.

"This is the one time of the year people on Medicare can change coverage," Lee Phillips said. "We're trying to get the word out. Our data shows that many seniors wait until the last minutes, and there is still time for people who don't know about the deadline or who are still trying to decide.

Phillips was talking primarily about Medicare Advantage, or "Part C" in government lingo. A short primer:

Medicare parts A & B are administered directly by the government, with Part A available at no charge once you turn 65 and Part B set a $174.2o per month for 2024. The premium is typically deducted from a person's Social Security payments. The two cover hospitalization and a lot of outpatient services such as doctor visits, but combined they can still leave a person paying 20% of the costs, and they don't cover drugs.

Medicare Part D covers prescription drugs, and the price for coverage can vary based on your needs. The government also arranged for "Medicare Supplement Insurance, or Medigap coverage through individual insurance companies. The cost can vary, but all Medigap plans are set to tight government requirements.

Advantage, or Part C, plans are different. The government contracts with individual insurance companies to offer coverage plans, giving the company the money it gets for Part B. The company decides what will be covered, and whether it will require any additional payment from the person being insured.

Companies can and do devise a pretty broad range of Advantage plans in an effort to better meet the varied needs of people seeking coverage. How many companies offer Advantage plans in your area, and how many plans each company offers, can be very different from region to region, and the plans themselves can change from year to year.

That's why Phillips encourages people to take a look at what's available each year, including now (if you haven't done so). If you have an Advantage plan you're happy with, don't assume it will offer the exact same coverage next year. If your health situation has changed, a different Advantage plan (or traditional Medicare) may better suit you. If your financial situation has changed, you may need to switch to something you can better afford. Or there may be a new plan that covers what you already have for less.

"For 2024, Highmark introduced plans with zero-dollar premiums as well as zero dollar co-pay for primary care, physical therapy and other costs," Phillips said. "Many include preventive and comprehensive dental, as well as other additional dental services."

Dental, vision and hearing services typically aren't covered by traditional Medicare and — according to medicare.gov — generally aren't covered by Medigap policies.

It is important to point out that when insurance companies say a Medicare Advantage plan has a "zero-dollar premium," it means you don't have to pay anything beyond what is already deducted from your Social Security for Part B. If, for example, you signed up for Medicare Part B and opted for an Advantage plan but were not yet getting Social Security (perhaps you retired at 66 but are waiting until you turn 70 for maximum SS payments), you would have to pay the premium to the government until you enroll for Social Security benefits.

Complicated? It sure can be, which is why Phillips notes her company, like most, offers help via phone or online. If you want help picking a Highmark Advantage plan, call 888-398-1570 or go online at medicare.highmark.com. They are operating under extended our right now, from 8 a.m. to 9 p.m. Monday through Sunday. And on Dec. 7 they will be available until midnight.

If there's a different insurance company you are familiar with, consider searching their website for Medicare Advantage (Part C) plans. You can find out which plans are available where you live on the website medicare.gov. And you can either compare directly on that site, or use the information to contact a specific company for more information. There are also local brokers who do not represent a specific company. The state Department of Aging provides help as well, available through the PA MEDI Helpline at 1-800-783-7067 (the local number for Luzerne County is 570-624-3027).

What about those ads with Joe Namath, some other celebrity or some mild-mannered spokesperson urging you to call their toll-free line? Phillips said those services often cover the entire nation and aren't particularly familiar with where you live, making a local broker a safer bet. "Dealing with folks who call those national number I've found that they ask for your ZIP code and try to see based on your income and where you live what you're eligible for," she said. "Your local advisers are going to know the most about plans you are eligible for."

Reach Mark Guydish at 570-991-6112 or on Twitter @TLMarkGuydish