Congratulations! You have made your decision of the Medicare Health and Drug Plan for 2013. For many, this might mean that you stayed with the plan that you had in 2012 and for some, you may have looked at the options available in your area and have enrolled with a new Medicare plan. The decision that you made is for the calendar year 2013: so let’s look at some ways that you can use the plan to your “advantage”— after all, they are called Medicare Advantage Health Plans.
When you receive your health or drug plan packet that includes the evidence of coverage and other important information, make sure you and your caregiver take a moment to look at what the plan covers and how to access those services. Also, if you would like someone else to be able to ask questions of your plan on your behalf, take a moment and fill out the “authorized representative” form. This is always better done sooner rather than later.
First, what should we NOT do? We should not assume that your neighbor, friend or family member has the same plan as you and ask them what providers to use. Plans have different rules and different providers. A health maintenance organization (HMO) works very different from a preferred provider organization (PPO). We have seen many a Medicare member be responsible for a medical bill because they went outside the allowable network.
What should we do? Understanding what type of plan you have enrolled in is the first step; we have several different types of plans in Hawai‘i including HMOs (you must use the plan’s network or their contracted providers) PPOs (you can use both preferred providers (and pay less money out of pocket), PFFS (works with any provider who accepts the plan and agrees to treat you) and SNP (special needs plans that are available for those with Medicare and Medicaid), who are the providers and how can you save the most money.
Still have questions, first call your health or drug plan (remember when possible it is best to call later in the afternoon in Hawai‘i and you will have less of a wait time), they are best able to answer the questions about your specific coverage. You can always find the phone number on your membership card.
Are you new to Medicare in 2013? Join us on our “Welcome to Medicare” webinars that are held in February/April/June/August. To sign up for one, go to www.hawaiiship.org and look for the webinar box. Certified SHIP volunteers are also available to help you navigate the Medicare system. We can be reached at 1-888-875-9229. The Hawai‘i SHIP receives a federal grant from the Centers for Medicare & Medicaid Services to provide information and assistance to you regarding your Medicare benefits. The program is located under the Department of Health’s Executive Office on Aging.