What Your Doctor Wants You to Know Before Getting Medicare
If you’re approaching 65, or are 65 or older, you know what time it is. Medicare Annual Enrollment Period (AEP)!
This period runs from October 15 to December 7 each year. You can make changes to existing Medicare coverage, and any changes will take effect on January 1 of the following year.
But what many people forget when enrolling in Medicare for the first time, or changing up coverage, is that your beloved primary care physician and healthcare specialists may not accept certain kinds of Medicare coverage.
For example, some clinicians may not accept Medicare Advantage plans (Part C) and only accept Original Medicare (Part A and Part B) and any added Part prescription drug plans or Medicare Supplement plans (e.g., Plan F, or Plan G).
Below are four things doctors wish patients would think about before enrolling in Medicare or changing their coverage.
1. Checking what Medicare options your current PCP accepts
When getting Medicare, there are two ways to obtain the two core parts—Part A and Part B—and not every primary care physician will accept both.
You can get Medicare Part A (hospital insurance) and Part B (medical insurance) from either the federal government (Original or Traditional Medicare) or a private insurance provider via a Medicare Advantage plan.
When you get a Medicare Advantage plan, you get your Part A and Part B benefits from the private plan provider. But with Original Medicare, this is managed by the federal government.
What is critical before enrolling in Medicare or changing to/from Original Medicare, is finding out what your primary care physician accepts if you wish to keep them. We see many of our patients forget to check if their providers accept Medicare Advantage and then lose access to the provider after enrollment and feel shocked and distraught, so we encourage all our patients to ask what Medicare options their physicians accept if they want to keep them following Medicare enrollment.
Note: We do not accept Medicare Advantage plans but do accept Original (aka Traditional) Medicare.
2. Researching Before Enrolling
Another mistake we see from our older patient is not doing enough exploration and research before enrolling. When getting Medicare for the first time, it can be overwhelming and confusing. We recommend doing the following prior to enrollment:
Sit down with your primary care physician and discuss your essential health needs
Make a list of current healthcare costs and financial budgets, and how Medicare may impact that
Make a list of all prescription drugs and research how Medicare may cover them. If you choose Original (Traditional) Medicare, be sure that you also select a Medicare Part D option to help pay for prescription medications.
If you see specialists, find out if they (a) accept Medicare; (b) what part of Medicare will cover them; and (c) if you need either supplemental coverage or to plan for a larger financial investment
3. Yes, You Can Switch Your Coverage
Sometimes we see patients choose a Medicare Advantage plan and hate it. But what many forget is that when the Medicare Annual Enrollment Period comes around – you can change it! Specifically, if you have a Medicare Advantage plan and want to go back to Original Medicare, you can do that.
Current Medicare Advantage plan holders also get a second chance to make changes between January 1 and March 31. Known as the Medicare Advantage Open Enrollment Period (MA OEP), during this time, people already enrolled in a Medicare Advantage plan can switch to another MA plan or drop their MA plan and return to Original Medicare.
4. Your Spouse’s Medicare Coverage May Not Work for You
Just because your partner has chosen a specific Medicare option, does not mean you should too. One of the biggest mistake we see couples make is getting identical Medicare coverage. Yes, you are partners and likely have some health similarities, but at the end of the day, you’re not identical.
Spouses should consider their own unique health needs and lifestyle when choosing Medicare coverage. Everything from the prescription drugs you take, doctors you see for your pre-existing health conditions, and if you travel for work and don’t want to worry about hefty out-of-network fees. All these little things matter when selecting the appropriate Medicare coverage options.
Need Help with Medicare?
Do you still have questions about your Medicare coverage options? We’re happy to help. Give us a call at 972-394-8844 or contact us online here.
We can also recommend some great online learning resources here from Medicare.gov.