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Health > More Health StoriesFall 2011 IS Magazine10/19/11 IS Online

Shopping for a Medicare Plan

By Craig DeSilva

Will you still need me
Will you still feed me
When I’m 64?

Times have changed since The Beatles first sang that song more than 40 years ago.

These days, reaching age 64 doesn’t just mean “you can knit a sweater by the fireside” or “Sunday mornings, go for a ride.” Many of today’s 64-year-olds are active, involved members of our community. They are volunteering or going back to school to remain physically and mentally engaged. Many continue to work in their present jobs or switch to new careers. No matter how you spend your time when you’re 64, it’s important to start planning for your health care future to keep you healthy so you can do the things you enjoy.

Once you reach age 65, you will be eligible for Medicare benefits. However, Medicare only pays a portion of your medical costs. You should not expect that the benefits you receive from your job will be the same as Medicare. In many cases, it is less. That’s why many retirees choose to enhance their coverage with a Medicare plan offered through health plans like HMSA.

Last year, HMSA introduced a new Medicare health plan called Akamai Advantage, a Medicare Advantage plan that offers benefits greater than original Medicare. This year, Akamai Advantage health plan options feature new, improved benefits that cost from $0 a month to $60 a month, depending on what plan you choose. With Akamai Advantage, retirees receive medical and prescription drug coverage with no or low deductibles that go beyond original Medicare. Akamai Advantage also includes dental discounts and preventive benefits, such as HMSA365 discounts on health and wellness services and products, health education classes, health risk assessments, health coaching, and more.

If you’re eligible, you should plan to apply for Medicare during the three months before the month you turn 65. With no penalty, you can apply during the initial enrollment period – three months before your birthday month, on your birthday month, and three months after your birthday month.

Even if you already have a Medicare health plan, you should reassess your health status and budget every year since your health and plan benefits change every year. You have the opportunity to change to another health plan during the open enrollment period, Oct. 15 to Dec. 7.

Whether you are new to Medicare or already have a Medicare plan, it’s important that you plan ahead and do your homework to choose a health plan that’s right for you. Your decision will help you stay healthy so you can do the things you love, such as “doing the garden, digging the weeds” or spending time with “grandchildren on your knee.”

Who could ask for more?

Choose a Medicare plan to fit your health needs and budget.

When it comes to shopping for a Medicare health plan, one size doesn’t fit all. You need a health plan that fits you.

Even if you already have Medicare, it’s important to re-evaluate your health plan every year. Benefits and costs change every year. So do your budget and health status. You can change health plans during the open enrollment period from Oct. 15 to Dec. 7. This is a change from last year’s Dec. 31 deadline.

Here are some important factors to consider when choosing a health plan:

Health status. Do you have a chronic condition that requires a lot of doctor visits, treatments, and medication? Do you require specialty care in addition to seeing a primary care provider? Do you expect to be hospitalized or need surgery? If so, you may want a health plan with a high level of hospital coverage. If you are in relatively good health and need coverage “just in case” for emergencies, you may consider a plan that costs less with features that fit your health status, such as one with a $0 monthly premium. However, keep in mind that you risk paying more out-of-pocket costs if you are hospitalized due to an emergency or unexpected illness. Also, if you travel a lot, you may consider a plan that has Mainland or worldwide coverage.

Budget. Consider what your out-of-pocket costs will be, including monthly premiums, copayments, and deductibles. How much can you afford? The cheapest plan may not necessarily save you money in the long term or if you have a serious medical condition and are admitted to the hospital for a long period. Also, find out what is your plan’s out-of-pocket maximum (the most you pay in a year for Medicare-covered services. If you exceed that amount, the health plan will pay the rest).

Prescription drugs. Are the medications you’re taking covered under the plan? What will your copayment be? Which pharmacies are in the plan’s provider network?

Doctors and hospitals. Is your doctor or hospital in the health plan’s provider network? Keeping your doctor helps ensure the continuation of your care. Not all plans offer an extensive network like HMSA.

Customer service. Is customer service available to answer your questions during local business hours? Can you meet with a representative in person for personalized service?

Health and wellness. What kinds of preventive care programs are available to keep you healthy? These would include health education classes, health coaching, and discounts to gym memberships and other health and wellness products and services.

Reputation. Is the health plan financially stable and reputable? Does it have an adequate financial reserve for emergencies? Is it nationally accredited? For example, HMSA is Hawai‘i’s most experienced health plan that has been part of generations of Island families for almost 75 years.

HMSA’s Akamai Advantage is designed to offer you a variety of health plans to meet your health needs and budget. It’s important you research and plan early to find the best plan for you.

Island Scene Online is not intended to replace the advice of health care professionals. Please consult your physician for your personal needs and before making any changes in your lifestyle.
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