How to Make the Most of My Insurance

Dear Lura:

My husband and I are new to Medicare and will be going through our first open enrollment period this fall. There is so much to learn and so many options to consider! We are finding it to be more than a little overwhelming.

My sister-in-law keeps telling us to enroll in a Medicare replacement plan so we can save money. But we are a little reluctant to do that. It feels like we have more control if we stick with traditional Medicare.

Do you have any suggestions for us or any resources we can review before we make our decision? I know this is the only time all year we can make changes, so we want to make the most of it.



Medicare and Insurance Options for Seniors

Dear Dawn:

You aren’t alone! So many seniors are struggling to work their way through the options and make an informed choice.

Traditional Medicare

Let’s start with traditional Medicare. It is made up of several parts. Here’s what you should know:

  • Medicare Part A will help pay for the expenses associated with inpatient care. It might be a hospital stay or a rehab stay at skilled nursing center.

  • Medicare Part B is what covers outpatient care including physician office visits, preventive care (flu shots and screenings) and outpatient rehab services.

  • Medicare Part D is designed to help with prescription drug expenses. While all Medicare Part D plans must meet federal standards, not all plans are the same. It’s important to review each plan and compare it with your list of prescriptions.

Traditional Medicare generally covers 80% of seniors?۪ medical costs, and the senior is responsible for the other 20%. It is important to note that there is no limit on out-of-pocket costs for Medicare Part A and B expenses. You can purchase a supplemental insurance plan to help with this gap in coverage.

Medicare Replacement Plans

A Medicare replacement plan is legally obligated to cover the same services that a senior’s traditional Medicare would. In some cases, these plans actually provide broader coverage such as a health club membership or vision assistance.

The downside is that these plans usually limit which providers you can see. This can be especially problematic if you and your husband are one of Ohio’s many snowbirds who head south during the winter months.

My final tip is to utilize the Medicare Plan Finder to search by zip code for plans that meet your criteria. You can review which providers are included in the plans and how each plan is rated based on a 5-star performance rating system.

I hope this information helps you and your husband, Dawn!

Lura Sandy