Here’s what to keep in mind and how to get your questions answered during Medicare’s annual enrollment period

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By Amanda McElfresh, amcelfresh@theadvocate.com

Natchitoches Wood

This article is brought to you by Blue Cross and Blue Shield of Louisiana.

There’s no doubt that choosing the right Medicare coverage can be a challenge. With multiple plans and options available, it can take time to review all of the details and decide what is best. However, there are ways to make the process a bit easier.

When reviewing and choosing a Medicare plan, many experts suggest people remember the three Ps: provider, pharmacy and plan value.

“It’s critical that a person looks at plans that have a premium that they can afford so they can keep more money in their pocket each month,” said Mike Bertaut, a health care economist with Blue Cross and Blue Shield of Louisiana. “If a senior is on Medicare Advantage, there are some plans that have very low premiums. They should look at all of them and decide what best fits into their budget and gives them the best plan value.”

In addition, Bertaut said individuals should closely look at all hospitals and doctors that are covered by each plan. If medical facilities or physicians are not in a plan’s network, it can mean high out-of-pocket costs for patients.

“It doesn’t do you much good if the hospital you want to go to is not a part of your plan,” Bertaut said.

He also noted that most people are on several prescription medications by the time they become eligible for Medicare. That means a person should take a close look at their medications and ensure their plan covers those costs.

“You don’t want to move into a health plan and have to tweak the drugs you need because the plan does not cover them,” Bertaut said.

Deborah Smith, a Blue Cross and Blue Shield of Louisiana Medicare Benefit Specialist, said that in addition to considering the three Ps, people should also look at a plan’s maximum out-of-pocket, or MOOP. Smith said that amount refers to the most a person would pay out of pocket during the plan year.

“Many people think about basic health care costs and prevention, but in the back of your mind, you always want to make sure you have the protection you need in case something major does happen,” Smith said. “Having that maximum out-of-pocket limit ensures you do not spend more than you have budgeted. That is something people sometimes overlook, so it’s important to review those numbers.”

While there are no major changes to the Medicare plans this year, Smith noted that many providers are continuing to offer more telehealth services. Those became popular at the beginning of the COVID-19 pandemic, but are now becoming a standard option for patients who prefer to receive care from the comfort of home. Also, Smith said more people are receiving medications via mail order rather than picking them up at a pharmacy.

Both Smith and Bertaut said the best option for people new to Medicare or struggling with enrollment is to work with an experienced agent to review the plans and go over all details. Blue Cross agents are available every day to speak with members.

“By working with somebody who is familiar with Medicare, they can help you navigate the system. It’s kind of like having a tour guide to show you everything,” Smith said. “It’s especially important because everything is individualized. You can have three people who all live next door to each other, and all three can have different Medicare plans that fit their needs. When you work with an experienced and trained agent, you can make sure you have the plan that is right for you.”

Bertaut noted that Blue Cross has agents located in Louisiana. Members may contact them by phone or online. There is no charge to speak with a Blue Cross agent.

“Health insurance can be complex. There’s no substitute for having a person who is willing to sit down with you and go through the details and get your questions answered,” Bertaut said.

One of the best things about working with an agent is that it’s an ongoing relationship, not just during enrollment. Blue Cross agents are available year-round to make sure members get the most out of their plan and have a resource they can turn to when they have questions or need help.

This is especially important because healthcare fraud is growing, with Medicare-age adults most likely to be targeted. Blue Cross Medicare member Jimmy Davis knows about identity theft firsthand. He worked with Blue Cross to make a video about his story and how his agent worked with him to make sure he stayed covered. Davis’ video can be seen on the Blue Cross and Blue Shield of Louisiana YouTube channel, www.youtube.com/BCBSLA.

The Medicare annual enrollment period runs through December 7. For more information or to connect with an agent for free with no obligation, call 1-800-568-1417 (TTY 711) or visit www.bcbslaplan.com/medicare.