By Debbie Gardner
After years in the insurance industry, Keith Aubin founded Integrity Medicare Advisors – a licensed agency that provides free Medicare advising for elders – after helping his grandmother enroll in a Medicare plan. Here’s what he told Prime about being ready for Open Enrollment:
Q: Medicare Open Enrollment continues through Dec. 7. Is there a worksheet that will help you select a program that’s right for you?
“To start, I have clients prepare a list of the medicines they take so they can check every plan’s formulary [list of drugs covered and at what level] as part of their research. But it’s not only drugs that you need to make a list of, also all of your doctors - primary care and specialists - even chiropractors and mental health care providers. You need a list of every medical practitioner you have interaction with, and the proper spelling of their name. Also list every facility that is important to you - Baystate Medical Center, Mercy Medical Center, Mass General, Dana Farber - those that are immediate and those you think you might need access to in the future.
“Once you have your lists, and your Medicare beneficiary number, you are ready to begin comparing plans to make the best choice for your needs. A service such as the SHINE [Serving the Health Insurance Needs of the Elderly] counselor at your local senior center, or myself, can help you sort through all the information.
“If you are tech savvy, you will find resources on the Medicare website at medicare.gov. For example the site has a prescription drug finder; you put in your drug, it asks for frequency you take it, the dosage, and the pharmacy you use.When you have completed all the questions, it will give you sometimes 10, 20, 30 different options where you live that you can compare and filter. The site also allows you to do that with Medicare supplement plans and Medicare Advantage plans as well.
“In addition to the medicare.gov site, each insurance carrier has helpful information - and more specifics - about the plans they offer, including extra benefits such as an allowance toward eyeglasses, or dental work that might mitigate some out-of-pocket spending. It’s also important to look at where the plans are available, as not every Medicare plan or Medicare Advantage plan is available in every area.”
Q: I understand Medicare Advantage plans are now offering new benefits to enrollees for 2021. Can you detail what these benefits are, and how to access them?
“We are seeing insurance carriers offering new fringe benefits with their Medicare Advantage plans - everything from cards that can be used to offset the cost of over-the-counter drugs to allowances for items like eyeglasses and hearing aids. Many plans are really thinking outside the box with these benefits.
“One thing to look for in your Medicare Advantage plan is any dental coverage. This insurance is usually expensive for elders, so if you have an option that covers any dental procedures, it is important to know about it and take advantage of it.”
Q: Are there common mistakes that people make when they enroll in /renew their Medicare plans? How can they avoid these mistakes?
“The biggest mistake Medicare enrollees make is thinking they have to go it alone when trying to evaluate their plan. Help is available from your local SHINE counselor or a service such as mine. Use your local senior center as a sounding board. Don’t get overwhelmed.
“The second mistake is not making sure you have all the data you need to make an informed decision. There are four major areas you need to consider. The first is cost - is your plan cost staying the same, or is it increasing significantly? The next is the formulary - does the plan still cover your drugs, and do so affordably. The third is core benefits - are all your doctors and facilities still covered by your plan. The fourth is fringe benefits - what is your plan offering in the new cycle? Are there comparable plans that might offer benefits that could help mitigate your costs?
“The third mistake is not seeking help with costs. Massachusetts residents have to the MassHealth Buy-In program, which helps with Medicare Part B premiums if you qualify. There is also a federal program that helps with copays for prescription drugs. And there is a program called Prescription Advantage that helps pay for drugs when an elder hits the “donut hole” - the period between maximum Part D drug coverage and the annual prescription drug cost maximum.
