Men and Medicare: What You Need to Know
Next year, more than 1.6 million American men will turn 65. Discounts await you at restaurants, cinemas and hardware stores. They also await new options regarding health care coverage that their parents and grandparents never had the luxury of considering.
For generations past, turning 65 meant getting health care coverage through Medicare, and the only real decisions were whether or not to enroll in supplemental coverage, and if so, with whom? All of that changed with the passage of the Balanced Budget Act of 1997, which allowed Medicare beneficiaries the option of receiving benefits through Medicare Advantage (MA) plans. (Many older people had previously done this through a series of demonstration projects dating back to the early 1980s.) Those plans were expanded in 2003 with the landmark Medicare Prescription Drug Modernization and Improvement Act, which provides a prescription drug benefit for seniors and people living with disabilities.
MA plans provide all of the traditional benefits found in Medicare plus a host of additional benefits designed to make the plans attractive and appealing to the specific health and lifestyle needs of an older person. These additional benefits could include dental, vision, fitness, transportation, and personal case management membership, especially for those with chronic conditions. But what plan to choose and how to make that decision?
For men entering the world of Medicare for the first time, this can be particularly challenging in areas where multiple providers offer a variety of plans leaving seniors with dozens of options to choose from. When making this important decision, here are five things to consider:
• Remember that you are making this decision for YOU, not your spouse, child, or other dependent. When selecting a commercial carrier, most people consider what is right for the health needs of themselves and their family. But turning 65 is an opportunity to be selfish, what works for you? If you are 65 and healthy, you may want a relationship with a health plan that simply says “I’ll be there when you need it” and agrees to interact with your plan through discreet online health information and programs. preventive care that fit your busy lifestyle. But if you have chronic conditions, your main concern may be affordable doctor visits, managing complex drug regimens, and extra help from care managers navigating the health care system.
• Medicare has a quality rating system in which plans are rated from one to five stars, with five being the highest. The system was established to help educate consumers on quality and make quality data more transparent and comparable between plans. The rankings consider factors such as clinical outcomes, access to preventive services such as screenings and vaccinations, management of chronic conditions, preventive care, and consumer satisfaction. Star Ratings are calculated each year and may change from year to year. Use them to help you make your decision.
• Monthly premiums and copays can vary significantly from plan to plan. The good news is that some MA plans have no monthly premium at all in 2016. But there are more costs than just premiums. Carefully review the deductibles and copayments you will need to pay when you go for care. Consider what best suits your needs and wallet.
• Many seniors take multiple medications to help manage chronic conditions in the long term, and out-of-pocket costs for medications can vary widely between health plans. Take a look at your pharmacy coverage and be prepared to ask the right questions. Are my medications covered? What are copays? Are there discounts to make maintenance medications more affordable, such as getting a three-month supply of medications at a retail or mail-order pharmacy and paying for just two months?
• The availability of a person’s doctor in the health plan’s network is one of the most important factors when choosing an MA plan. This is particularly important for those entering the Medicare population for the first time. See which plans your doctor and hospital participate in. Provider networks can vary greatly from plan to plan, so don’t be surprised.
The annual enrollment period for people eligible for Medicare is currently in progress (ending December 7). Aging men on Medicare should embrace this new chapter in their lives and make smart, informed decisions about their ongoing health care needs. Few decisions are that important.