Insurance Exec Offers Tips and Information on Selecting Medicare Plans

Gloria Paradiso, Vice President, Blue Cross Blue Shield of Massachusetts took the time to answer some of our questions about Medicare enrollment and different kind of plans...

Q: Are there any aspects of Medicare enrollment that are unique to Mass, given that we have a lot of rules on regular health insurance, more than some states, I believe?

A: Medicare is a federal health insurance program funded by the government, so while residents in Massachusetts don’t need to learn state-specific rules, there are a lot of Medicare plan options here, which can make it challenging to navigate the enrollment process. In addition to national health plans who market their options here in Massachusetts, there are quite a few Massachusetts-based organizations who have offered Medicare plans in this state for many years, including Blue Cross Blue Shield of Massachusetts. We’ve also seen some newcomers to the market in the last few years. What’s most important for each Medicare shopper is that there is no one-size-fits-all plan. Every individual’s needs are different, so each person should look for information from trusted sources so they can better understand their options and the process for enrolling in Medicare.

Q: How do private insurers like BCBS play a role in complementing or administering Medicare?

A: There are two primary ways that eligible individuals get Medicare coverage – through Original Medicare, which is offered by the federal government and covers Medicare Parts A and B, and Medicare Advantage, which is offered by private health plans such as Blue Cross Blue Shield of Massachusetts and others.

Medicare Advantage covers Parts A and B but, in addition, most also include Medicare Part D, which helps cover the cost of prescription drugs. And what makes Medicare Advantage through private health plans an attractive option for many individuals is that it also includes a lot of supplemental benefits, such as dental, vision and hearing coverage.

Some private health plans also provide other benefits that shoppers may not be seeking but can be really helpful in a time of need, such as programs that help members transition from the hospital to home. At BCBSMA, for example, we offer Medicare Advantage members access to an on-staff dietician and a broad team of mental health professionals that offer guidance, education and support to promote mental and emotional well-being, to name a few additional benefits.

Q: What is the impact of inflation on Medicare?

A: It’s natural to have questions about health care and health costs when we hear about inflation, and this year’s Inflation Reduction Act includes some key changes to Medicare that impact all beneficiaries. One important change is that, starting now, there is a $35 a month cap on insulin, which is extremely important for those who have struggled with the rising cost of insulin. Other relief from out-of-pocket drug costs will be phased in beginning in 2024.

It's important for seniors to know about the short-term and long-term impact of the Inflation Reduction Act as they shop for plans, but it can be confusing because many changes are not being implemented this year. We encourage shoppers to find trusted sources of information, either online or at seminars that health plans like BCBSMA frequently host, so they can get their questions answered.

Q: How have Medicare plans evolved to provide more mental health resources to seniors?

A: Seniors today expect their Medicare plans to go beyond the basics, like seeing a behavioral health professional, when it comes to mental health. It’s estimated that 20% of people 55 years old or over experience some type of mental health concern, so it’s important that Medicare beneficiaries and their caregivers find the mental health benefits best suited for their unique needs. For instance, some seniors may not realize that good nutrition can help relieve stress, and certain Medicare plans help seniors with benefits specifically tied to nutrition. Some plans can also help seniors relieve stress through telehealth support or with wellbeing activities that fit their needs and goals. As an example, Blue Cross Blue Shield of Massachusetts offers complimentary access to Learn to Live, which provides online programs to help individuals overcome mild to moderate anxiety, depression and insomnia. Seniors are encouraged to look closely at each plan’s offerings to ensure that the plan they choose covers the services they need and allows them to find their behavioral health provider of choice.

Q: What is your top piece of advice for individuals who are making important Medicare decisions in the coming weeks?

A: It’s very important to know where to find the right information and guidance. Understanding Medicare can be a confusing and overwhelming process, with many coverage choices, acronyms, premium levels and enrollment rules. It’s complicated, so try to understand the basics and how the system is structured before you start to shop. You may also consider important questions when you evaluate your choices, such as: is my doctor in the network? Will I be covered if I travel outside of Massachusetts for long periods? Are my drugs covered? When you understand Medicare and your plan options, you can make informed decisions, for yourself or your loved ones. And when you find a plan that works for you and that you can afford, you will be more likely to take advantage of your plan’s benefits and stay healthy in the long run.

[ED. NOTE: Much additional information can be found at https://www.medicare.gov ]