Is Your Health Plan Working for You?

Credit: Courtesy of Cigna

If the pandemic is teaching us anything, it's that maintaining good health is of paramount concern. I know firsthand – not only because I'm a doctor, but because I contracted COVID-19 last fall. I recovered, but my experience reinforced for me the importance of having a health plan that meets my needs when I need it most.

People who are 65 and over will have a chance to make sure they have the coverage they need during the Medicare Annual Election Period (AEP), which runs from October 15 through December 7. If you're Medicare-eligible, now is the time to start thinking about your health needs and plan your strategy. Remember, you can sign up or switch your Medicare Advantage plan during AEP. Any changes you make will take effect on January 1, 2022. If you are happy with your current plan, you don't need to make any changes.

The key is understanding your benefits and also anticipating the health care you may need next year. Our health status changes year to year as we enter new phases of life.

Wondering where to start? I recommend always starting with you. You know yourself better than anyone. Think about where you are in terms of your health and expectations for what you'll need in the year ahead and go from there.

If you already have a Medicare plan, make a list of what you like about it. What are the aspects of it you consider mandatory – for example, a favorite doctor, vision coverage or a fitness benefit. Will you need to see a specialist in the near future? Are you planning on moving? Review and compare your plan against other available plans based on those needs.

As with other important life decisions, choosing your health plan can be daunting and confusing. The good news is there are many information resources available to you. Ask advice from your doctor, friends and family until you're comfortable. You can also have your questions answered by experts through in-person or virtual seminars and phone calls with independent health plan brokers or by visiting the state health insurance assistance program in your area.

Here are a few of the essential tips to keep in mind this year when reviewing plans:

To estimate total costs, first, know your plan's current premium or monthly cost. Second, check your Annual Notice of Change (ANOC) letter mailed in late September for any changes to out-of-pocket costs, including co-pays and deductibles on doctor and hospital visits and prescription drugs. Finally, check to see what the cost will be if you need to see a specialist. In some plans, you may pay more if you go outside your network and may need to fill the gaps with supplemental insurance.

Another reason you might want to change your coverage is that your plan no longer has your favorite doctors in the network. Make a list of the doctors and any specialists you expect to visit in the upcoming year. Confirm that your current providers are still in your plan or any new doctors you will be visiting accept new patients. If not, you might either have to change plans or switch doctors to avoid paying higher out-of-pocket costs.

Make sure you review the drug pricing tiers to know whether your Medicare Part D prescription plan will cover your current medications and the costs. Some drug plans might require prior authorization for certain brand-name drugs.

Pay attention to extra benefits not available with original Medicare but which may be built into a private insurer's Medicare Advantage plan at no additional cost, such as dental, vision, transportation or even an allowance for purchasing certain over-the-counter items. There may also be other health and wellness benefits that help you stay healthy such as fitness programs or telehealth for non-emergency medical care.

As some travel restrictions are being eased, or even if you have a second home in another state, consider a plan with those needs in mind.

Be prepared by visiting Medicare's Plan Finder at Medicare.gov or Medicare plan websites such as www.cigna.com/medicare. Having a checklist of questions will make it easier when reviewing all your options.

Remember that it's up to you to be sure your health plan works for you. Once you've found one that meets your individual needs, take advantage of the benefits so you can thrive all year long.

The information contained in this article is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen. To learn more, visit https://www.cigna.com/medicare.

By Cigna Healthcare

Cigna Corporation (NYSE: CI) is a global health services company dedicated to improving the health, well-being and peace of mind of those we serve. Cigna delivers choice, predictability, affordability and access to quality care through integrated capabilities and connected, personalized solutions that advance whole person health. All products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Evernorth companies or their affiliates, and Express Scripts companies or their affiliates. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits, and other related products. 

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