Column: How to get the most out of your Medicare


Commentary by Mandi Baker

Many Americans have recently enrolled or changed Medicare health plans effective Jan. 1. Understanding your Medicare benefits and how to make the most of your Medicare could have a significant financial impact.

Understanding the difference between Original Medicare (Part A and Part B) and Medicare Advantage Plans (Part C) and their benefits can eliminate confusion and frustration. Original Medicare offers coverage for medically necessary services with deductibles, co-pays and co-insurance. Under Original Medicare, there are no networks. You can use any health care provider who accepts Medicare.

One thing to keep in mind, there is no coverage for prescription drugs, however, you can enroll in a standalone Part D plan with Original Medicare.

Medicare Advantage Plans, also known as Part C, are offered by private insurance companies providing an “all in one” alternative to Original Medicare. These plans include Part A, Part B and usually Part D, and will typically provide additional benefits that Original Medicare does not, such as dental, vision, hearing and more. One thing to keep in mind with Medicare Advantage Plans is the provider networks. To receive benefits for your care, you will need to stay within your provider network, some plans have coverage out-of-network at a higher cost sharing to you.

Utilize preventative care and vaccines benefits

Preventative care helps keep us healthy by identifying health issues before they become problems. Both Original Medicare and Medicare Advantage Plans cover health screenings such as mammograms, prostate cancer screenings and much more. Many vaccines are covered such as the flu, pneumococcal and COVID-19. Verify your plan benefits for a complete list of covered services.

Understand your Prescription Drug Coverage options

Original Medicare does not typically provide coverage for prescription drugs unless they are Part B medications. Individuals with Original Medicare should consider purchasing a standalone Prescription Drug plan, Part D, to provide coverage and cost savings for prescribed medications. Medicare Advantage plans often have Part D benefits included. To maximize cost savings with your prescription drug plan, be sure to use your plan’s preferred pharmacies or mail order pharmacy. Ask your doctor about alternative medications that may be a generic or lower tiered (lower cost) medication on your plan’s formulary. Other ways to reduce prescription drug cost is to consider the pharmacy’s cash retail price or compare cost with one of the many prescription discount programs.

Use an agent

Getting help from people you trust, learning about your Medicare coverage choices and comparing different plans can help you understand all the options available to you. To better understand your coverage, contact your local trusted agent to review your benefits and go over any extra features the plan may offer. Agents can help you understand not only your plan benefits, but the many ways to maximize those benefits and explore additional cost saving measures specific to your needs.

Mandi Baker is the Director of Meridian-Penn Marketing Group. She works with independent agents and agencies, including Shepherd Insurance, in furthering their Medicare insurance careers.