Top Tips for Navigating Medicare Decision-Making

By Gloria Paradiso, Vice President & Head of Government Sales at Blue Cross Blue Shield of Massachusetts

Medicare is confusing and making informed decisions can seem overwhelming. To help you during the annual enrollment period, Blue Cross Blue Shield of Massachusetts (BCBSMA) is offering these valuable tips for Franklin Observer readers to guide enrollees toward the right choices for their healthcare needs.

1. Understand the basics of Medicare: It’s important to be familiar with the fundamental structure of how Medicare works to make better-informed choices. Attend an informational seminar, such as the year-round seminars hosted by Blue Cross Medicare experts, or speak with a local expert. Take advantage of the free SHINE program, which offers meetings with certified counselors who provide unbiased Medicare information.
2. Plan your budget: Medicare plans offer different options for balancing your costs and expenses. It’s important to find a balance that provides both adequate coverage and affordability. Consider how much your premiums, deductibles, copayments and other expenses will cost. Weigh factors such as out-of-pocket (OOP) limits, as well as how much you’d pay for services like hospital stays, doctor visits, prescription drugs, and vision, dental and hearing care.
3. Ask if your providers are in-network: Some Medicare plans require you to choose a hospital and healthcare providers from a network. Compile a list of your regular providers and determine if each is in-network for the plans you are considering, in order to avoid unexpected out-of-pocket costs.
4. Evaluate your health: Assess your current health status and make a list of the services and medications you typically require to help you identify the plan that best suits your needs.
5. Look beyond the basic benefits: Original Medicare handles medical services and supplies in hospitals, doctor visits and outpatient services but does not include prescription drug coverage, vision, dental or hearing care. Determine which additional benefits are important to you and factor them into your plan decision.
6. Be thorough: Take advantage of available resources before making your Medicare choice. Visit medicare.gov and the websites of different carriers to better understand available options. Many, including BCBSMA, let you compare plans on one screen. Also talk to trusted friends and family members who can share their experiences and recommendations.
7. Understand what’s new for Medicare in 2024: Reduced insulin costs, savings on out-of-pocket expenses for prescription drugs, and better mental health care coverage are among the most significant changes for 2024 Medicare plans. It’s important to find trusted sources of information to better understand how these changes may impact your plan decision.
8. Familiarize yourself with the Medicare enrollment periods: There are specific times of the year when only newly eligible individuals can choose a plan and other times of the year when anyone can make a change (open enrollment). Familiarize yourself with these dates so you can make an informed decision during the annual enrollment period (Oct. 15 – Dec. 7), when anyone eligible for Medicare can switch plans.