Mastering Medicare, part 2: Strategies for maximizing benefits, managing costs and filing appeals
Understanding the full spectrum of the benefits offered by Medicare is key to maximizing your plan and in turn, maximizing your quality of life.
According to Alex Uhm, VP, General Manager of Medicare at Blue Shield of California, there are several lesser-known strategies that can help you make the most of your Medicare plan.
Read on to find out what an expert has to say about Medicare benefits you may have overlooked, out-of-pocket costs, managing appeals and more.
Lesser-known Medicare benefits
Medicare offers a wide range of benefits that many seniors might not be aware of. These include:
Preventive services: Medicare covers numerous preventive services such as wellness screenings, vaccinations, and annual check-ups. These services are essential for early detection and management of health issues.
Home-care services: For those who need assistance at home, Medicare can cover certain home health care services, which can be a lifeline for seniors wanting to maintain their independence.
Supplemental benefits: Depending on the plan, Medicare may offer additional benefits like vision, dental, over-the-counter medicines, grocery supplies, and transportation services. Seniors may also find plans that offer allowances for food and produce, supporting nutritional needs as part of overall wellness. Seniors can choose between Medicare Advantage or Medicare Supplemental plans to access these benefits.
Uhm emphasizes that Medicare isn’t one size fits all — seniors choosing a new Medicare plan should prioritize their specific needs and consider plans that offer a wide range of products and services that accommodate their lifestyle and budget.
Prioritizing preventive care
Preventive care is a cornerstone of staying healthy, and Medicare provides extensive coverage for preventive services. Uhm tells us seniors should:
Schedule regular screenings: Work with health care providers to discuss and schedule necessary screenings and preventive services.
Use reminders: Some health plans, such as Blue Shield of California, send periodic reminders to beneficiaries to schedule routine check-ups and screenings.
Medicare beneficiaries should also understand the full range of preventive care options available to them and work with their providers to make sure these services are scheduled. Blue Shield of California, for example, offers Medicare Advantage members the following preventive and wellness benefits:
Hearing: Exams to diagnose hearing problems, balance disorders, and ringing in the ears if ordered by a healthcare provider
Vision: Eye exams and coverage for eyeglass frames, lenses, or contact lenses
24/7 Physician consultation: Access to phone or video visits anytime
Over-the-counter healthcare products: A quarterly allowance for items such as cold medicine, first-aid supplies, and pain relievers
SilverSneakers fitness: Free access to participating gyms and wellness resources online or in person
At your annual wellness visit, be sure to ask your provider which screenings or services are recommended for your age and health history to make the most of Medicare’s preventive care offerings.
Handling out-of-pocket costs
Uhm laid out some actions seniors can take to effectively manage out-of-pocket costs. His best tips include the following:
Enroll on time: Avoid late penalties by enrolling in Medicare plans promptly.
Choose the right doctors: Select doctors who accept Medicare and charge no more than Medicare-approved rates.
Consider Medigap plans: These supplemental plans can help cover costs that original Medicare doesn’t, reducing out-of-pocket expenses.
Evaluate Medicare Advantage plans: Also known as Part C, these plans can be cost-effective as they include all original Medicare benefits plus additional services such as embedded pharmacy benefits and supplemental coverage.
See if you qualify for “Extra Help”: This federal program assists people with limited income in lowering their Medicare Part D prescription drug costs. Some are enrolled automatically, while others must apply through the Social Security Administration.
Annual plan review
Uhm also pointed out how crucial it is for seniors to review their Medicare plans annually to stay informed about any changes and ensure the plan still meets their needs. Important documents to review include:
Annual Notice of Change (ANOC): This summarizes changes in benefits and costs for the upcoming year.
Evidence of Coverage (EOC): This detailed document outlines all plan benefits, member rights, and processes.
Navigating the appeals process
If a Medicare claim is denied, don’t panic — Uhm explains that understanding the appeals process is key. He recommends that you take these steps:
Review the denial reason: Educate yourself on why the claim was denied to prepare for the appeals process.
Keep all documentation: Maintain copies of all documents related to the appeal.
Follow proper procedures: Adhere to all steps and timelines detailed by the health plan.
Provide supportive documentation: Include letters from healthcare providers to strengthen the appeal.
By staying informed and proactive, seniors can maximize their Medicare benefits and manage their healthcare effectively.
*This article contains general health information and is intended for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider if you have medical questions and before making any decisions or changes related to your health.
This story was originally published July 30, 2024 at 1:40 PM.
