As the time for Medicare open enrollment nears, people often have many questions.
One of the biggest is: Which plan is best for me?
With so many options to choose from -- Original Medicare, Medicare Advantage, and both national and local plans -- it’s an important question to ask. The answer lies in understanding your specific health needs and wants.
Original Medicare vs. Medicare Advantage
The health care coverage you get from a Medicare Advantage plan is different from Original Medicare. Medicare Advantage plans are offered by private insurance companies and can include coverage for Part A (inpatient care in hospitals), Part B (doctor’s visits), and Part D (prescription drugs). Many also offer extra benefits like dental, hearing, fitness, and more not covered by Original Medicare.
3 recommendations for finding the most appropriate Medicare coverage
Brandie Gamboa, director of Medicare Advantage Plans at Community First Health Plans, a local Medicare Advantage provider located in Bexar County, has a few recommendations before you enroll:
- Research all the Medicare Advantage plans before selecting the best one to fit your needs.
- Review whether your doctors are in the plan’s network and if your current prescriptions are covered.
- Review all deadlines so you don’t miss your opportunity to enroll in the appropriate plan for you, and so you don’t face penalties for not having credible coverage.
“The most important deadline is to enroll in Medicare by Dec. 7, as we are currently in the annual enrollment period,” Gamboa said. “Your benefits will take effect Jan. 1.”
Is a local Medicare plan right for me?
If you’ve done your homework on all the plans that a national provider can offer, your next step might be to investigate what a local provider can offer.
One of the most important things a local provider can offer that is different from a national plan is in-person, dedicated assistance.
Gamboa said Community First has a walk-in community office located in the historic Avenida Guadalupe neighborhood. It is staffed with helpful, knowledgeable bilingual representatives who can provide assistance to seniors to apply for coverage, understand and use their health plan benefits, and more.
Community First offers Medicare Advantage plans to Bexar County residents that provide all Part A, Part B, and Part D benefits, plus hearing, dental, vision, and other services through local organizations.
“Being local, we are able to negotiate with our trusted local network of providers to provide more affordable coverage,” Gamboa said. “We also invest back into our community to ensure our members have access to local resources that can help them with needs beyond health care. We sponsor yearlong fuel for RideConnect so that they can provide low- or no-cost transportation to seniors, and we also partner with House of Neighborly Service to sponsor meals for seniors.
Community First also offers a Dual-Eligible Special Needs Plan (D-SNP) for individuals who have been diagnosed with certain conditions or diseases or those with low incomes.
Access to extra benefits through a Medicare Advantage plan (not included in original Medicare)
Local Medicare Advantage plans give you access to extra benefits that are not included in original Medicare.
“Some extra benefits you will receive include vision, dental and hearing, and coverage for glasses and hearing aids,” Gamboa said. “We also provide an over-the-counter allowance to purchase health-related items and no-cost non-emergency transportation to wherever you get Medicare services.”
Gamboa said there’s so much more, too. With Community First Medicare Advantage Alamo HMO Plan, you can get a variety of additional perks, such as:
Home-delivered meals after an inpatient hospital stay. This ensures members can get nutritious, high-quality food that’s based on preferences and needs. There are diabetic-friendly and heart-friendly meals that are delivered fresh, refrigerated and microwaveable.
Health and wellness programs. Depending on your needs, there are various programs that include management of asthma, diabetes, behavioral health, lifestyle and blood pressure.
Free fitness memberships. You will have access to free classes and equipment to increase physical activity and social interaction, as well as means to learn about healthy lifestyle skills.
Access to a nurse advice line. You can reach a registered nurse 24 hours a day, seven days a week, 365 days a year. A nurse can help you with any follow-up questions after a doctor’s visit, determine whether a symptom warrants an urgent care or doctor’s visit, or any other questions you might have.
Emergency response system. You can rest assured you will have immediate help in case of a fall, injury or medical emergency through an electronic monitoring and emergency response system that’s designed to connect you to help 24 hours a day, seven days a with, with the push of a button.
Making a decision
As you’re in the investigation phase of selecting the most appropriate Medicare plan, consider all the options in front of you.
“Community First Health Plans strives to build strong community relationships that can help our Medicare members above and beyond providing health care coverage,” Gamboa said.
To learn more about Community First Medicare Advantage plan options, click or tap here. You can also call 833-434-2347 to speak with a licensed representative who can help seven days a week, from 8 a.m. to 8 p.m. (Oct. 1 through March 31). TTY users can call 711, 24 hours a day, seven days a week.
You can enroll in a Community First Medicare Advantage plan from Oct.15 through Dec. 7.
Community First Health Plans, Inc. is an HMO/HMO SNP with a Medicare and Texas State Medicaid Agency Contract. Enrollment in Community First Health Plans, Inc. depends on contract renewal. Community First markets under the names Community First Medicare Advantage Alamo Plan (HMO) and Community First Medicare Advantage Dual Eligible Special Needs Plan (HMO D-SNP). This information is not a complete description of benefits. Call 1-833-434-2347 or 711 for more information. You must continue to pay your Medicare Part B premium.