One week remains for the 2018 Medicare Open Enrollment process. Medicare Part A (inpatient hospital insurance) and Part B (medical insurance) beneficiaries may opt to enroll into a privately managed Medicare Advantage plan, e.g., health maintenance organizations (HMOs) and preferred provider organizations (PPOs) or private fee-for-service plans. Medicare is a federal healthcare program that benefits seniors and certain Congressionally recognized needy populations, such as persons living with a disability regardless of age. Although exceptions may apply for additional Medicare Advantage plan changes, as permitted by law under special enrollment or certain special circumstances, most individuals must adhere to the Medicare open enrollment process now to lock in their 2018 Medicare Advantage coverage and projected pharmaceutical needs.
In Massachusetts, approximately 21 percent of the 1.2 million Medicare recipients have chosen Medicare Advantage plans to manage their healthcare costs, access to health care, and medications. The Massachusetts Medicare Advantage plans offer benefits in addition to traditional Medicare, such as transportation to and from medical appointments, which could also benefit adult caregivers of senior parents or disabled family members. Hearing aids, vision screening, and dental benefits are also common considerations in plan selection, as well as financial caps that limit consumer cost sharing.
Most Massachusetts Medicare Advantage plans, however, do not provide coverage for members that travel outside defined geographic areas. Further options will allow Medicare beneficiaries to disenroll from Medicare Advantage and return to traditional Medicare, as well as to select Medicare Part D prescription-drug plans, tiers of coverage, required copayments, and/or to assess the purchase of a Medigap policy, if eligible.
Useful Massachusetts and federal resources include the following:
- 1-800-243-4636; TTY 1-877-610-0241 http://www.mass.gov/elders/
- 1-800-243-4636 (Serving the Health Insurance Needs of Everyone (SHINE) in Massachusetts) https://www.mass.gov/health-insurance-counseling
- https://medicare.com/state/massachusetts-medicare/ (Medicare in Massachusetts)
- U.S. government’s Medicare website, www.medicare.gov
- https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf (Medicare & You 2018)
Lorianne M. Sainsbury-Wong, Esq., CPCO | MBA Health Law Section Council, Ex-Chairperson, and MBA Civil Litigation Section Council Member