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Understanding the type of Medicare coverage you need

Open enrollment for Medicare is October 15 through December 7. This is the period — if you’re eligible for Medicare — when you can make new selections to your plan that will apply for the following calendar year. Now is the best time to ask yourself if you know the difference between Original Medicare, Medicare Supplement and Medicare Advantage. This will help ensure you get the coverage you really need.

Original Medicare provides hospital and medical insurance, but doesn’t cover all expenses. Medicare Supplement plans are in addition to Original Medicare. Sold by private insurance companies, they help pay for costs after Original Medicare pays its share. The extra cost of a Supplement plan to bridge these gaps, however, can result in overspending for coverage you don’t need.

A Medicare Advantage plan offers similar benefits to Original Medicare — and more — often at a lower price. These plans pay for costs in place of Original Medicare. Also sold by private insurance companies, they typically include Part A Medicare (hospital), Part B (medical) and Part D (pharmacy) coverage — an aspect not covered by a Supplement plan. In addition, extras like fitness benefits, vision and dental are often included in an Advantage plan.

Key differences between Advantage and Supplement plans

  • Advantage replaces Original Medicare while Supplement adds to Original Medicare.
  • Advantage plans have lower premiums than Supplement plans.
  • Supplement plans only cover expenses covered by Original Medicare while Advantage plans may cover extras that Original Medicare does not.
  • Benefits vary among Advantage plans, giving you the flexibility to find a plan that best fits your needs and lifestyle. Supplement plans offer the same benefits per plan without customization.

Benefits to an Advantage plan

OSF recommends choosing an Advantage plan rather than a Supplement plan for better overall coverage. Here’s why:

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  • Advantage Plans may have low to $0 premiums while providing extra services like dental, vision and hearing.
  • Providers appreciate partnering with Advantage plans because these plans help keep patients safe and healthy through wellness programs and services, like care coordination, health coaching, preventive reminders for screenings, vaccinations and much more.
  • The Centers for Medicare & Medicaid Services (CMS) makes sure all Advantage members have access to in-network providers. By choosing an Advantage plan accepted by OSF HealthCare, you can ensure access to a wide range of specialists and be certain you’ll have access to the OSF providers you know and trust.

Seeing your health care provider when you aren’t sick might not feel like a top priority. But an annual wellness visit can help you stay your healthiest. It’s a chance for you and your provider to talk about preventing disease or catching it early, when treatment works best.

Annual wellness visit

You can have an annual wellness visit if you’ve had Medicare coverage for longer than 12 months. You can schedule this visit once a year with no cost to you.

What to expect

During an annual wellness visit, Medicare requires your provider to:

  • Complete a medical and family history on your first visit and update this history yearly
  • Update the list of providers and others who provide care to you and any medical equipment you use
  • Screen for mental functions, such as memory and reasoning or depression
  • Conduct a safety screening to ensure you can safely get around on your own
  • Check your height, weight, vision and BMI (body mass index)
  • Provide education about your conditions
  • Order screening tests
  • Refer you to specialists for any concern
  • Develop a screening test schedule for the next five to 10 years
  • Provide a list of your personal risk factors and recommendations to address them
  • Provide personal health advice based on the information collected
  • Discuss end-of-life planning

A separate visit may be needed

The annual wellness visit does not include a physical exam. If you want to complete a physical exam, you must schedule a separate visit with your provider.

Remember, if your health care provider performs certain tests or services during the annual wellness visit appointment, you may have to pay coinsurance and a deductible if these tests or services aren’t covered under the preventive benefits of Medicare.

Need help?

Click here to get extra guidance to determine what plan is right for you. Resources include a list of plans accepted at OSF HealthCare facilities and local experts who can help.

About Author: Lisa Coon

Lisa Coon is a Writing Coordinator for OSF HealthCare, where she has worked since August 2016.  A Peoria native, she is a graduate of Bradley University with a degree in journalism. Previously, she worked as a reporter and editor at several newspapers in Iowa and Illinois.

She lives in Groveland with her husband and son. In her free time she likes to cook, bake and read. She freely admits that reality TV is a weakness, and she lives by the quote, “The beach is good for the soul.”

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Categories: Wellness