Find The Medicare Plan That's Right For You

Medicare recipients, listen up. Open enrollment — the time when you can change your Medicare coverage plan — is Oct. 15-Dec. 7.

Now is the time to review your drug benefit plan and any additional coverage plan to make sure it’s still the best one for you.

I know: Poring over the numbers and the multitude of plans isn’t exactly the most fun way to spend an afternoon or a weekend. Some have compared it to untangling a 150-bulb strand of holiday lights. But just like the relief one feels when the lights twinkle, you’ll be glad you did, knowing you’re getting the most bang for your buck and not overpaying for unnecessary or outdated coverage.

If your life circumstances or your medications have changed, it’s crucial that you evaluate your coverage because what was good for you five years ago may not be a good fit today. Not only are benefits changing, but also plans and the medication tiers within those plans change. As an example, recent legislation that changed Medicare drug pricing capped the cost of insulin at $35 a month.

In my role at MUSC, I oversee health care delivery to more than 20,000 Medicare beneficiaries across the state. My mother is one of them. Years ago, when she signed up for Medicare, she added a Medigap policy, which supplements the original Medicare plan, and a Part D drug plan. For years, they worked for her, and she had no reason to change them.

Then her health and her medications changed. One of her medications dropped off her drug plan’s formulary, meaning it was no longer available at the original cost. For the last two years, we’ve had to appeal the status of that medication and get it approved so she can get it without expensive copayments.

So How Do You Begin?

For starters, go to the Medicare website and enter where you live. Then enter the medications you routinely take and get different cost estimates for what the coverage would be for those medications. Estimate what you think your expenses might be for the next year and then determine how they fit with your Medicare plan. Where do you prefer to receive your health care? Answering those questions will refine your search and help you decide whether to keep your current coverage or find something more appropriate for your circumstances.

If you do decide to make any changes to your coverage, make sure your current doctors will be in that network. This is an important consideration for people who have established relationships with doctors they know and trust. If I were reviewing plans, I would want to make sure I have my doctor and hospital names to be sure they are in network. I recommend doing that instead of calling your doctors’ offices.  MUSC Health and all its physicians, of course, participate in original Medicare and as many other plans as we can.  You can also find the MUSC Health plans here.

At MUSC Health, our highest priority is the health of our patients. We want to continue our relationships with our patients, and we want them to be able to afford their care. We understand that between 25 and 50 percent of patients have challenges affording their medications; many patients also have transportation challenges.

If you’re facing challenges to obtaining care, talk to your doctor’s office staff about them. We want to be aware of factors that impact someone’s health even if it’s outside health care. There are things we can do to help with that, but we must know so we can help.

If you’re new to Medicare or turn 65 within the next year, getting the right plan and knowing when to apply for Medicare is important. Based on age, and other circumstances, there are specific windows on when to apply for Medicare. And it will be different for every individual health plan.

If you’re still working at age 65 and have health insurance, you’ll have the option of going on Medicare or staying with your insurance as long as you’re working. If you don’t have health insurance and continue working without applying for Medicare at age 65, you could face a penalty.

Bottom line: Everybody has a different situation. Different plans exist for federal retirees, military retirees, state retirees and those who have commercial insurance.

Be diligent; understand your situation and enroll in the plan that’s best for you.

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Dr. Louder is chief of the MUSC Health Alliance, a clinically integrated network formed by MUSC that allows the MUSC hospitals and physician practices to work closely to improve the quality of health care delivered to MUSC Health patients.