Medicare: A Recipe For Success

Medicare can be confusing. With the right information, you’ll be ready to shop for a plan and choose the right one for you and your needs. As you compare plans, benefits, and prices, it’s important to keep a few key things in mind.

1Many people take one or more medications on a regular basis. Review the drug formulary to make sure the medication(s) you take are covered by the plan. Make sure to check: n Drug brand names and generics n Prior authorization requirements n Prescription tiers and the associated costs

2What may have been a great plan may not suit your needs anymore. Remember to review your plan and coverage every year. Always keep your eyes out for: n Provider and facility network: In-network versus out-of-network. Are your doctors and facilities covered on your current plan? n Monthly premiums: This is the monthly bill you pay for your coverage. n Out-of-pocket (OOP) maximums: This is the total amount you may pay for services covered each year. n Copays and coinsurance: You may have copayments or coinsurances to pay for services. Copays are fixed amounts, and coinsurance is usually a percentage of the cost you pay. n Bonus perks: What options, tools, and services are included on your plan? Find out about gym memberships, OTC items, vision and dental, and other extras. Some perks may cost more.

3Wading through the hundreds of insurance companies can be downright exhausting. For starters, there are several categories to consider: n Not-for-profit vs. for-profit: Who is the priority—you or shareholders? For-profit companies must return profits to investors while not-for-profits must reinvest their profits back into the plan to benefit members. n Customer service you deserve: This is a big deal! Can you talk to a local person on the phone? When you need answers, you need a real person to make things happen for you.

4The Centers for Medicare and Medicaid Services (CMS) use a five-star quality rating system. The Star Rating can tell you about a company’s customer service, member satisfaction, benefits, and overall quality. Companies receive an updated rating annually, making it easy to weed out less than the best. ~

Editor’s Note: This article was submitted by Darin Vickery, Idaho-based Medicare Sales Executive for SelectHealth. darin.vickery@selecthealth.org or 208-338-2019. See ad on page 59.