A Prescription for Good Health: Selecting the Right Health Insurance Plan

Dr Julie Stroud

As a physician, the last thing I want is for a patient to make decisions about their health and well-being based on the cost of care and medications rather than their actual health care needs.

We are currently experiencing a critical time for the more than 250,000 people in Montana who rely on Medicare for their health insurance. Assessing your own health care needs can help you select a plan that will cover you when you need it most and that will fit your budget.

While it is impossible to predict every health condition that may require treatment, there are several things to consider during the Medicare Advantage and Prescription Drug Plan Annual Election Period (AEP), which runs from June 15 October to December 7:

• Future health risks: In addition to making sure your plan covers your current health needs, talk to your doctor about health risks that might require additional treatment. For example, if you have prediabetes, consider the potential for future diabetes management.

• Benefits of Prescription Medicines: Prescription drug coverage is included in many Medicare Advantage plans, unlike Original Medicare. If you prefer Original Medicare, you can opt for a stand-alone prescription drug plan with a private insurer. Prepare a list of your current medications to compare costs when choosing plans.

• Doctors and hospitals: If you have a preferred doctor, make sure they accept your plan to avoid any additional expenses for out-of-network providers. Also understand if the plan requires referrals to specialty care.

• Other benefits: Consider additional benefits that can positively impact your health and well-being. Medicare Advantage plans may include dental, vision and hearing coverage; fitness programs; transportation for doctor visits; and even benefits that help eligible recipients pay for healthy foods and other essentials, like rent and utilities.

• Costs: Different plans have different costs, so understand the big picture when comparing plans in your area. Review monthly premiums, deductibles and co-payments for hospital stays and doctor visits. Also pay attention to the annual out-of-pocket maximum: If you reach the limit, you won’t pay anything for covered services the rest of the year.

• Quality: The Centers for Medicare & Medicaid Services (CMS) annually reviews and evaluates all Medicare Advantage plans prior to the enrollment period to help consumers make informed decisions. Plans are rated on a scale of one to five, with one indicating poor performance and five indicating excellence.

Your mutual insurance company is a partner that helps you get the care you need. If you are eligible for Medicare, take the time to research your options and be sure to select the plan that best meets your personal health and financial needs.

The Medicare Plan Finder on Medicare.gov can help you compare plans and benefits and get an estimate of the cost of each plan.

For more information, visit Medicare.gov or call 1-800-MEDICARE (800-633-4227) 24 hours a day, seven days a week (TTY users should call 1-877-486-2048 ). You can learn more about Humana’s plans at Humana.com/Medicare or by calling 1-800-706-1368 (TTY: 711) from 8 a.m. to 8 p.m., seven days a week to speak with a licensed sales agent.

Dr. Julie Stroud is vice president of Montana Health Services, Humana