- Todd Ray is senior vice president, provider network management and Medicare products at BlueCross BlueShield of Tennessee.
When shopping for goods and services, cost is most often the determining factor. For those preparing to shop for health care coverage, that’s never been more true.
We’ve all felt the impact of inflation on food and gas prices, and these concerns will likely carry into the holiday season as many Tennesseans travel and exchange gifts. As families continue to face high prices, many of us are in the market for health coverage we don’t receive from an employer — and weighing options that fit in our budgets.
For seniors, the Medicare annual enrollment period runs Oct. 15-Dec. 7. For others looking for a plan through the federal health insurance Marketplace, open enrollment runs Nov. 1-Dec. 15 for coverage effective Jan. 1, 2023. (Marketplace open enrollment ends altogether on Jan. 15; later-enrollment coverage begins Feb. 1.)
Those interested in Marketplace plans should first visit healthcare.gov and follow the prompts to see if you qualify for financial assistance (many people do) and to view plans in your area. It’s easy to compare plans. For help finding a plan that fits your needs, you can work with a broker or navigator, or directly with a plan carrier.
On the Medicare side, shoppers should visit ssa.gov to begin enrolling in a Medicare Supplement plan, Medicare Advantage plan or Part D plan. Medicare.gov offers a comparison tool that will let you compare plans offered in your area.
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Some things to consider
- Cost considerations include the plan’s monthly premium, copayments or coinsurance for services you use, and the projected cost of prescriptions. But it’s important to look beyond the dollar signs to uncover what you’re getting for your money. Other categories to consider are:
- Networks: Research your preferred hospital and health care facilities, your primary care provider, any specialists you see, and your pharmacy to see if they’re covered by your plan of choice, as well as your backup plan options.
- Extras: Commonly referring to dental, vision and hearing aid benefits, “extras” within some plans even cover gym memberships or meals following a hospital stay. A popular money-saving extra is an Over the Counter (OTC) allowance that covers certain OTC items like vitamins and pain relievers.
- Quality: For Medicare plans specifically, Medicare evaluates based on a five-star quality rating system, with only a select few receiving all five stars. This rating can be used as a crucial decision point when deciding between two plans.
Even knowing those category boxes to check and what URL to enter into your browser, it can be difficult to start shopping effectively. After all, there’s no checkout line or Amazon shopping cart for a health plan.
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How to obtain assistance
For those needing to speak with someone about options, be they Medicare or Marketplace, talk with a plan carrier about community meetings offered through clinics and hospitals. These are often organized through churches, neighborhood associations, local government, etc. You can find in-person help from an assister, agent or broker in your community at localhelp.healthcare.gov.
For phone assistance from BlueCross, call 1-800-845-2738. BlueCross also has eight Blue of Tennessee at Sanitas Medical Centers within the state (four in the Nashville/Murfreesboro area, four in Memphis. Walk-ins will receive assistance from BlueCross representatives who can answer questions and help you enroll in a plan that’s right for you.
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We’ll also host informational sessions, both in-person and virtual, to educate Medicare-eligible individuals throughout October and November. To find one in your area, visit bcbstmedicare.com/meeting.
This year has been marked by families looking at household budgets with renewed scrutiny. Our hope at BlueCross is that we can help alleviate the stress that undoubtedly comes with shopping for your health plan for 2023.