In the coming year, more than 1.6 million American men will turn 65. Discounts at restaurants, movie theaters and hardware stores await. Awaiting, too, are new options regarding healthcare coverage that their parents and grandparents never had the luxury to consider.
For past generations turning 65 meant obtaining healthcare coverage through Medicare and the only real decisions were whether or not to enroll in supplemental coverage and, if so, with whom? That all changed with the passage of the Balanced Budget Act of 1997, which allowed Medicare beneficiaries the option of receiving benefits through Medicare Advantage (MA) plans. (Many seniors had previously doing so via a series of demonstration projects that dated back to the early 1980s.) Those plans were augmented in 2003 with the landmark Medicare Prescription Drug Improvement and Modernization Act, which provides a prescription drug benefit for seniors and people living with disabilities.
MA plans provide all of the traditional benefits found in Medicare plus a host of additional benefits designed to make the plans attractive and appealing to a senior's specific health and lifestyle needs. These added benefits could include dental, vision, gym membership, transportation and personal case management, especially for those with chronic conditions. But which plan to choose and how to make that decision?
For men entering the Medicare world for the first time, this can be particularly challenging in areas where multiple carriers offer a variety plans that leave seniors with dozens of options from which to choose. When making this important decision, here are five things to consider:
• Remember that you are making this choice for YOU, not for your wife, child or other dependent. When selecting a commercial carrier, most people consider what is right for the health needs of both themselves and their family. But turning 65 is a chance to be selfish – what works for you? If you are 65 and healthy you may want a relationship with a health plan that simply says "Be there when I need you" and are fine with interacting with your plan through unobtrusive online health information and preventative care programs that fit your busy lifestyle. But if you have chronic conditions, your main concern may be affordable physician visits, managing complex medication regimens, and additional help from care managers in navigating the healthcare system.
• Medicare has a quality rating system in which plans are ranked from one to five stars, with five being the highest. The system was established to help educate consumers on quality and make quality data more transparent and comparable between plans. The rankings consider such factors as clinical outcomes, access to preventive services such as screenings and vaccines, managing chronic conditions, preventive care, and consumer satisfaction. Star ratings are calculated each year and may change from one year to the next. Use them in helping to make your decision.
• Monthly premiums and co-pays can vary significantly from plan to plan. The good news is some MA plans have no monthly premium at all in 2016. But there is more to cost than just premiums. Carefully review deductibles and co-payments you'll be required to pay when you go for care. Consider what best fits your needs and wallet.
• Many seniors take several medications to help them manage chronic, long-term conditions, and out-of-pocket drug costs can vary quite a bit among health plans. Take a good look at pharmacy coverage and be prepared to ask the right questions. Are my drugs covered? What are the copays? Are there discounts to make maintenance medication more affordable, such as getting a three-month supply of drugs at either a retail or mail-order pharmacy while only paying for two months?
• The availability of an individual's doctor in the health plan's network is one of the most important factors in choosing an MA plan. This is particularly important for those entering the Medicare population for the first time. See in which plans your physician – and your hospital – participate. Provider networks can vary greatly from plan to plan so don't be caught by surprise.
Annual enrollment period for Medicare-eligible individuals is currently underway (and ends December 7). Men aging into Medicare should embrace this new chapter in their lives and make smart, informed decisions about their ongoing healthcare needs. Few decisions are as important.