EDMONDS — Finished shopping Black Friday and Cyber Monday sales? It’s time to buy or change your Medicare coverage by Dec. 7.
The Centers for Medicare & Medicaid Services recommends that you compare plans every year to keep up with changes in those plans and your own health needs.
You have a lot to choose from when looking at Part D and Medicare Advantage plans. According to the Kaiser Family Foundation, Snohomish County residents have 55 Advantage plans to choose from for 2023 — the most in the state, and more than the national average of 43.
Medicare Part A, or hospital insurance, is free for most people age 65 and older. But you pay for Part B medical/outpatient insurance, and also Part D drug/prescription insurance.
Original Medicare operates like a preferred provider network, where you can go to any provider that accepts Medicare, without referrals. In 2023, Part B will cost a minimum of $164.90 per month. But the drug plan is not included: you can buy a Part D plan for less than $2 per month.
Also, original Medicare has no cap on what you might spend out-of-pocket. Some folks buy a Medigap/Supplement, or use employer or Medicaid coverage.
Medicare Advantage plans frequently operate like an HMO. They are legally required to cap out-of-pocket expenses, and they almost always include prescription coverage. They also might cover extras that original Medicare does not, like vision, hearing and dental services.
Medicare Advantage plans are popular — 60% of the eligible population in Snohomish County is enrolled in one. But that doesn’t mean it is the best choice for your unique situation. For example, if you travel a lot and get sick, you might spend up to the out-of-network cap on your plan. That could be as much as $12,450 in 2023.
Based out of the Edmonds Waterfront Center, SHIBA advisors meet by phone, Zoom, and in-person at locations across Snohomish and Skagit counties. They provide education and guidance as Medicare-eligible people weigh their options.
“We’re required by oath to be unbiased,” said Suzi Haugen, a volunteer advisor for the past 10 years. “We don’t sell products, and we’re not involved in insurance. Really, what we do is educate.”
First-time SHIBA clients attend a short “Welcome to Medicare” workshop, offered most weeks by Zoom. After that, they can make a one-on-one appointment with an advisor.
It’s the busiest time of year right now, but as of last Wednesday, they still had a few openings before Dec. 7, said volunteer coordinator Sue Shearer.
The 32 advisors receive extensive training from both the Washington Office of the Insurance Commissioner and the Edmonds Waterfront Center’s own programming.
Haugen, a former human resources professional, was looking for something to do in retirement that would make her brain work hard. Through SHIBA, she helps people trying to meet their health needs, often with limited financial resources. So it’s not only “brain-exhausting,” but also “emotionally intense,” she said.
Importantly, a number of resources are available for people who face financial challenges in paying premiums or other medical bills. SHIBA advisors screen everyone for eligibility for those programs.
Other than that, ask your favorite doctors if they will accept original Medicare (most do) and which Advantage plans they will contract with in 2023.
As The Daily Herald reported last week, Regence plans and Optum — the parent of The Everett Clinic and The Polyclinic — have not agreed to a new contract for next year. As of now, Optum companies will be out-of-network effective Dec. 5, but Regence will cover claims from Medicare Advantage subscribers until the federal COVID public health emergency ends. Currently, that is Jan. 11, 2023. Federal law requires such coverage during emergencies or disasters.
The Daily Herald has since heard from Aetna Medicare Advantage members that Optum will not be in network for them effective Jan. 1, 2023. Aetna wrote in a statement that Optum ended the agreement only with the Medicare Advantage PPO and HMO networks, not the commercial network.
Aetna’s spokesperson wrote:
“During the last several months, Aetna has made significant efforts to avoid a termination and to reach a mutually satisfactory resolution for all parties. Aetna will continue to provide our Medicare Advantage members in the Washington market with access to a robust network that provides affordable care that is local, convenient and helps achieve better health.”
Optum has not yet responded to a request for comment.
Even if you can’t get an appointment with SHIBA before Dec. 7, Haugen recommends coming in any time during the year to get educated for the next open enrollment period. And for those enrolled in Medicare Advantage, you can change your plan once from Jan. 1 to Mar. 31.
SHIBA: edmondswaterfrontcenter.org/ewc-programs/shiba/ or 425-290-1276. The next Welcome to Medicare information session is Nov. 30 at 6 pm. Register online.
Medicare overview: medicare.gov/basics/get-started-with-medicare
Explore your options with this tool: medicare.gov/plan-compare/ or 1-800-MEDICARE
Research about Medicare: kff.org/medicare/
Joy Borkholder is the health and wellness reporter for The Daily Herald. Her work is supported by the Health Reporting Initiative, which is sponsored in part by Premera Blue Cross. The Daily Herald maintains editorial control over content produced through this initiative.