Choosing the right health insurance plan can be overwhelming. It may be tempting to just keep the plan you currently have rather than look at spreadsheets and dense, hard-to-decipher descriptions of coverage options.

That’s a mistake. Whether you’re over 65 and inundated with advertising about Medicare open enrollment options or getting your insurance through the Marketplace or working for a company whose annual open enrollment is taking place this fall, it’s imperative that we review our current plan and see what our options are for 2021.

Here are some things to keep in mind regardless of where you get your health insurance:

• It’s not all about premiums. To get a sense of how much you may spend during the year, you need to look at all costs including deductibles, co-pays, co-insurance, out of pocket maximums. Click here for an article that defines these and other key health insurance terms.
• The provider network may or may not matter to you. It’s a personal decision whether you want to trade lower costs for having to switch doctors, travel further, or have a smaller network to choose from.
• Look at the health care services you think you’re most likely to need and try to find a plan that meets your specific needs. For example, if you know you’re going to need a lot of physical therapy (PT) next year, it may make sense to pay more in premiums for a plan that provides better coverage of PT visits.
• Do you have a second home in another state? Provider networks will be important in this scenario.

Medicare
Medicare Open Enrollment started October 15 and you can’t watch TV these days without seeing commercial after commercial about different Medicare insurance options. During Medicare Open Enrollment you can:

1. Switch from Original Medicare to Medicare Advantage
2. Switch from Medicare Advantage to Original Medicare
3. Switch from one Medicare Advantage plan to another Medicare Advantage plan
4. Switch from one Part D (prescription drug coverage) plan to another Part D plan

​A few tips:

• Be sure to check the formulary (list of covered medications) in your current Part D plan and any Part D plans you are considering to make sure your medications are included. You can do this on Medicare Plan Finder.
• If you’re in a Medicare Advantage plan, be sure to check whether your providers will still be in network next year.
• You can download the Medicare Open Enrollment guide from the Medicare Rights Center.
• This article, 3 Ways to Prepare for Medicare Open Enrollment, has helpful advice. 

Health Insurance Marketplace and Employer Health Plans

• Open enrollment for the Health Insurance Marketplace/Exchange is from November 1 - December 15.
• Open enrollment timing and options for employer-based plans vary. 
• For either, here is some helpful advice about Choosing A Health Plan from FAIR Health.
• More general advice about open enrollment for health insurance and other benefits can be found here and here.

Bottom line: Be sure you understand your options, get your questions answered, and know your preferences (cost, access, convenience, willingness to accept risk, etc.) before you make a decision. Contact me if I can help answer questions or conduct an analysis for you. 

Medicare is complicated. There are a lot of “parts” as well as rules, enrollment periods, etc. I’ve started making 1-2 minute videos to explain different aspects of Medicare including what is open enrollment, what isn’t covered by Medicare, Parts A, B, and D, what is IRMAA, and more. I'll be adding to this "Medicare collection" periodically so subscribe to my YouTube channel to stay up to date.

Thank you Betsy Phillips, Realtor, Baird & Warner, for having me on your "Let's Chat" series to talk about patient advocacy!

Medicare's annual open enrollment period starts this month and that means there are A LOT of commercials urging people to switch plans. Here are some of my thoughts after seeing yet another one of those commercials...
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Since the beginning of the pandemic, I’ve received many calls and heard many stories about how difficult the visitor restrictions continue to be for hospitalized patients, residents of senior living communities, and family members. As the pandemic continues, more and more organizations and individuals have been voicing concern about the isolation of seniors in assisted living and skilled nursing facilities, as well as the lack of advocacy for hospitalized patients. While exceptions for end-of-life or compassionate care visits have been available throughout (for patients without COVID), they often require families to make painful, difficult choices about who can say goodbye in person. Rules for all of the above scenarios have changed, loosened and also vary based on geographic area and facility. Be sure to check the most recent policy of the health care facility or community in question. 
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Please use the information below to understand the issues as well as to advocate to visit your loved ones.

Hospital/healthcare settings:

The Beryl Institute recently released Patient and Family Recommendations for Addressing Visitation Policies during COVID-19. This policy statement emphasizes the importance of allowing a “care partner” to be in the hospital or any healthcare setting with patients. Anyone who has been in the hospital or had a loved one in the hospital knows how critical it is to have someone there with you: it’s usually difficult to understand and remember what the doctors are saying and ask meaningful questions when you are in a health crisis. Care partners also provide important information to health care providers that patients, due to physical illness, cognitive issues or just being overwhelmed, tired, or scared, may not remember to share on their own. While these recommendations include that “All patients must have the option to have a care partner present in the healthcare setting,” they also set out guidelines and responsibilities for care partners to keep healthcare personnel safe. The photo below shows some of the recommendations:

Please see my previous post about having an “In Case Of Emergency Kit” prepared - this will make it easier for your care partner!

Long term care settings:

The Centers for Medicare & Medicaid Services (CMS), has issued guidelines to states  regarding visitation of residents of long term care facilities. They note:

     While CMS guidance has focused on protecting nursing home residents from COVID-19, we recognize that
     physical separation from family and other loved ones has taken a physical and emotional toll on residents.
     Residents may feel socially isolated, leading to increased risk for depression, anxiety, and other expressions
     of distress. Residents living with cognitive impairment or other disabilities may find visitor restrictions and other
     ongoing changes related to COVID-19 confusing or upsetting. CMS understands that nursing home residents
     derive value from the physical, emotional, and spiritual support they receive through visitation from family and friends.

The guidelines address indoor and outdoor visits as well as compassionate care visits and visitor testing. See the photo below for some of the guidelines for indoor visits. Check the guidelines from your state and the long term care facility you wish to visit for more specifics.

How many of you have had a Telehealth appointment - either audio or video - since the COVID-19 pandemic started? I recently gave a presentation via Zoom to a group of about 25 older adults. I used the polling feature to ask if they’ve tried Telehealth and if they liked it. 80% reported that they had used it and thought it was great (the other 20% had not used it yet). Honestly, I was surprised at how many had used it AND liked it. This month’s blog provides some tips to make your Telehealth appointment successful. ​

Telehealth may transform how healthcare is delivered in the future. It cannot replace every type of clinical visit, but in many cases, it can be just as good as being there in-person — just without the hassle of having to get to a doctor’s office. If the HIPAA rules and insurance reimbursement changes stay in effect even after the COVID-19 Public Health Emergency ends, we’ll all need to get familiar and comfortable with these type of provider appointments. 

It’s important to know that Telehealth was always subject to strict HIPAA privacy and confidentiality rules. Any platform used for Telehealth had to be HIPAA-compliant. These HIPAA rules have been relaxed since the Public Health Emergency was put in place; this means that providers and patients are using any form of communication that works, including FaceTime, Google Hangouts, whatever.

Medicare has made some important changes to Telehealth. Currently, any provider who is eligible to bill for Medicare may provide and be reimbursed for services delivered as Telehealth. That includes doctors, nurses, mental health professionals, physical therapists, and more. They can bill patients for usual cost-sharing (co-pays, co-insurance) but they have the option to waive or reduce those fees. Also, the requirement that a patient had to see the provider in the past 3 years in order to have a Telehealth appointment is waived.

Here are some tips to make Telehealth easier and more effective:

• Tips regarding your device (phone, laptop, tablet):
  • Set up camera at eye-level
  • Test microphone and camera
  • Make sure the volume is on and that you know how to mute/un-mute yourself
  • Make sure your device is fully charged or plugged in
  • Close unnecessary programs
  • Adjust lighting - turn on overhead lights, block light from windows
• Tips regarding using a Telehealth app:
  • Download the app, if necessary, or use your browser if you have that option
  • Log in early in case you have a problem
  • Have the doctor/office phone number handy in case you have trouble logging in
• Still plan as if you are having an in-person visit:
  • Prepare  an “agenda” - What are your questions? What information do you need? What do you want to accomplish during the visit? 
  • Write down new issues, symptoms, medications
  • Have medication list handy - prescription and over-the-counter medications
  • Provide info on vital signs, if possible - height, weight, blood pressure, temperature, etc.
  • Pen and paper for taking notes
  • Someone can be with you, just as if you wanted to bring someone to an in-person appointment
  • Repeat instructions back to provider to make sure you understand correctly
  • Be sure to ask and be clear about next steps such as scheduling another appointment, lab work, new prescription, etc.

If you have other questions, please don’t hesitate to contact me.