New to Medicare

Those new to Medicare should take time to understand, stay informed, and be prepared for any costs or changes that may occur from year to year. Also, participants have certain responsibilities that pertain to maintaining their coverage and minimizing costs. A beneficiary’s responsibilities could depend on a variety of things—like their circumstances—and if they get help with some of these responsibilities. 

Things to Know

If you recently enrolled in Medicare, you should be aware of a few key things, like costs and ongoing coverage. Medicare coverage and costs are ultimately dependent on the type of plan (i.e. A, B, D, Advantage, etc) and usually correlate to coverage and costs the provider experiences for your care. Costs that usually fall on you, the recipient, are premiums, deductibles, copays, and/or other out-of-pocket costs. If a provider is faced with a change, like a change to the cost of services or prescriptions, they could change what’s covered under the plan or the prices they charge to recipients.

For example, you may experience a change to your drug costs and coverage because the prices may go up each year and your plan may cover the medications differently. It may result from the provider changing their prescription list (formulary) which classifies and categorizes prescription drugs and is used to determine coverage and cost. If this list changes, there could be changes to the person’s prescription coverage.

Depending on the plan, other costs could be based on the poverty guidelines, which also can change from year to year. Overall, Medicare has changed in many ways since it was created and there have been many new options added, which means that there could continue to be options or changes to existing options. There may also be gaps that Original Medicare doesn’t cover, however, that’s what Medigap (supplemental) insurance is for.

Participant Responsibilities

Various responsibilities could fall on the participant, depending on the circumstances and the plan or policy. If your situation changes, it’s your responsibility to take the appropriate actions to ensure your financial stability and well-being. Such actions may include changing Medicare plans, which can generally be done through open enrollment. This gives you the opportunity to shop around and make sure you’re getting the most for your Medicare dollar.

Other responsibilities involve how you approach your healthcare. For example, in situations where a change was made to prescription drug coverage, as discussed previously, a prescription drug could fall outside of what’s covered.

At this point, you may not be able to afford the drug anymore and might have to decide whether to work with their health care provider to find an alternative—or find a new plan and enroll when able. Overall, you should continue to stay informed, prepared, and aware of your options.

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Let Us Help!

Before deciding if a Medicare Advantage plan is right for you, it’s important to have all the information you need to make an informed decision. Located in northern Charlotte, Carolina Senior Benefits works with the top-rated insurance companies and has been helping people just like you through the health insurance process.

Through our work, we provide impartial guidance based on our years of experience to help you make an educated decision about your health care needs. Our agents are here to provide excellent customer service, making the process as easy as possible. Call (704) 765-4689 to see what benefits are available in your area!