Interview by Stephanie Hainsfurther
“If you are enrolled in a Medicare or Medicare Advantage plan, your mailbox is probably stuffed right now,” said Mike Wallace, vice president of growth and strategy for Optum New Mexico. “The annual election period (AEP) started October 15 and ends on December 7. It’s a good time to review and level set.”
Wallace is talking about the benefits provided by your Medicare or Medicare Advantage plan and the costs thereof. He said that the best things to do during this annual open enrollment are to: 1) talk with your primary care physician (PCP) about any health issues you are experiencing or that might be anticipated next year and 2) speak with a licensed health insurance agent (it’s free to you) about your options.
For instance, if you think you might need surgery in the coming year, you’ll want to check your present plan and look at any expected out-of-pocket costs. If you think you’ll need vision, dental or hearing benefits, review the coverage you have now with an agent who can answer your questions about what your current plan provides. Then check other companies’ plans to see how they compare in terms of what you will need in the near future.
“Identify your own needs,” said Wallace. “Is your PCP still in network? Are hospital visits or other surgeries coming up? Are you able to see a certain specialist? How about co-pays? It’s a combination of care that you need – primary, specialist, hospital – and the network you need, the types of services covered, the costs and additional benefits you might need coming up.”
And don’t forget Medicare Part D, which covers prescription drugs. Basic Medicare does not cover your prescriptions. Part D is sold separately by insurance companies but generally included with a Medicare Advantage plan.
Post-pandemic, behavioral health coverage is a main topic of conversation among parents, providers, health plans and the community. “It’s a priority area at Optum,” Wallace said. “In a Medicare Advantage Plan, in general, coverage for behavioral health care gets rolled into the plan.” Optum New Mexico believes strongly in the importance of behavioral health as part of the patient’s overall treatment plan.
Optum New Mexico also offers help at its 10 area clinics for those seeking an agent to discuss Medicare and Medicare Advantage during this AEP. Go to Medicare.gov for a complete source of information on what to review during this year’s AEP.