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Is That Covered? Review Your Medicare Plan During Annual Enrollment

(BPT) – Have your health needs changed over the last year? Medicare plans can change every year, and your health situation can also change. That means your current plan might not meet your current needs. South Mountain Memory Care in Emmaus, PA, recommends you closely check your plans to see if they cover dementia care.

Medicare Annual Enrollment, which runs Oct. 15 – Dec. 7, is the perfect time to review your plan to make sure you have the right plan for your health needs at an affordable cost for the upcoming year. With inflation hitting people’s pocketbooks, reviewing your plan this year is more important than ever.

Choosing a Medicare plan can be confusing, but the National Council on Aging (NCOA) and Aetna Medicare have teamed up to help beneficiaries cut through the clutter. They have answered some of the most common questions about Medicare.

How much does Medicare cost?

How much you pay for Medicare depends on the choices you make about coverage. A common misconception about Medicare is that it pays for everything. But in reality, i does not. You can choose Original Medicare — with or without a prescription drug plan — or a Medicare Advantage plan that combines hospital, medical and sometimes prescription drug coverage in one plan.

Original Medicare includes:

  • Part A: Hospital Insurance – This pays for hospital, skilled nursing facilities and hospice care.
  • Part B: Medical Insurance – This pays for doctor visits, outpatient hospital care and home health care.

In addition, people with Medicare can choose coverage through:

  • Part C: Medicare Advantage Plans – These are sponsored by private companies, and they include coverage for everything that Medicare Parts A and B cover, as well as other benefits and services. Medicare Advantage plans cap your annual out-of-pocket expenses for covered medical care. And they can give you some extra benefits, like vision, dental, hearing and even a gym membership. Most Medicare Advantage plans also cover prescription drugs.
  • Part D: Prescription Drug Coverage – These are plans sponsored by private companies that pay for prescription drugs.

When researching Medicare plans, it’s important to ask yourself some basic questions. These can help you understand your unique health needs and goals and choose a plan that will best help achieve them. It’s important to consider:

  • Does the plan fit your budget? Review all the plan’s out-of-pocket costs. Your out-of-pocket costs will vary depending on which coverage you pick and your medical needs. Be sure to note the plan premium, but also check out the deductibles, copays and coinsurance you’d have to pay (this is what the plan requires you to pay when you use a particular service).
  • Next, think about your current providers. Are your preferred doctors and hospitals in the plan’s network? That’s very important if you want to continue using them. This is a common area of confusion and dissatisfaction for beneficiaries – there are a lot of different Medicare Advantage plans and each have their own network. Does the plan allow you to access a non-network provider, for example?
  • And don’t forget your prescription drugs. Find out if the prescription drugs you take are included under the plan and what you will have to pay for them. For example, some Medicare Advantage prescription drug plans offer certain medications with $0 copays (depending on their drug list and drug-tier levels). Drug lists can change every year, so you’ll want to check annually whether your prescription medications are still covered under your plan and what you will have to pay for them.

What are out-of-pocket costs?

Out-of-pocket costs are what you pay for your medical expenses that aren’t reimbursed by your insurance. Each part of Medicare has different out-of-pocket costs that can include premiums, deductibles and copayments or coinsurance. Medicare Advantage plans cap your annual out-of-pocket spending, but Original Medicare does not.

Some plans have deductibles. A deductible is the amount you must spend before your Medicare plan pays for your insurance benefit. If you have a hospital stay, for example, Medicare Part A will kick in after you pay your deductible. Copays are a fixed amount, and coinsurance is a percentage you pay for covered services and medications after you’ve paid your deductible.

For Medicare Part B, you generally pay 20% of the cost for each Medicare-covered service. So, if a medical service costs $100, Medicare pays $80 and you pay $20. Each Medicare Advantage plan has an out-of-pocket maximum, which is the most you will pay annually for medical services that are covered by the plan during a plan year.

How does prescription drug coverage work?

If you choose Original Medicare, you can purchase a stand-alone Medicare Part D plan to cover the cost of prescriptions. If you choose a Medicare Advantage plan, prescription drug coverage may be included. What drugs are covered, which pharmacies are in-network and how much you pay will depend on which plan you choose.

To use your prescription drug plan for the first time at the pharmacy, all you need to do is bring your Medicare card, photo ID and plan membership card to an in-network pharmacy. You can fill your prescriptions as you need them, or you can enroll in an automatic refill program.

The choice is yours

Medicare Annual Enrollment is your chance to make sure your plan fits your needs and budget. Take the time to review your options and enroll during Oct. 15 – Dec. 7. Visit NCOA or Aetna Medicare for more tips and guidance.

South Mountain Memory Care focuses on high-quality, personalized care, and the safest possible environment for your loved one. South Mountain Memory Care is proud to offer a wide range of resident-focused daily activity programming to our residents. Each neighborhood offers activity space for group and one-on-one activities.

The brand-new building is a stand-alone memory care community, meaning that the entire building, staff, and programs, are designed to serve residents with cognitive issues. To ensure person-centered care and attention, we have accommodations for up to 28 residents. The building is divided into two neighborhoods (wings), each offering 10 private suites and 2 semi-private suites. South Mountain Memory Care is located in the Allentown suburb of Emmaus, Pennsylvania, and is easily accessible from the Lehigh Valley, New Jersey, and Philadelphia. For more information, go to

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