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'It can be overwhelming': Expert tips to navigate Medicare

Enrolling in or changing your Medicare Plan can be tricky. An agent breaks it down and offers advice to make sure you get the most out of your coverage.

OREGON, USA — It’s around this time of year when those already enrolled in Medicare or those who are eligible will get a notice in the mail.

“It’s a large packet and it can be overwhelming,” said Elma Friend, president of Willamette Valley Benefits.

Friend founded Willamette Valley Benefits, Inc., a Portland-area independent Medicare and health insurance agency. Her goal is to help clients understand their benefits and get the coverage that fits them best.

So, let’s start with the basics: What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older and certain younger people with disabilities.

“You age in at 65. You have to have worked 10 years or 40 quarters and paid into the system,” Friend said. “Younger than 65 is when there’s a disability and you have a couple of really big diagnoses like ALS and kidney failure that would allow you to get your Medicare right away.”

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There are different parts to Medicare, but Friend said only two are actually provided by Medicare: parts A and B.

Medicare Part A is your hospital insurance: it helps cover inpatient care in hospitals, skilled nursing facility, care and home health care.   

Medicare Part B is your medical insurance: it helps cover services from doctors and other health care providers, outpatient care, home health care, medical equipment and preventative services.

Then there’s Medicare Part D: this helps cover the cost of prescription drugs.

You can join a Medicare drug plan in addition to the original Medicare or you can join a Medicare Advantage plan with drug coverage.

Medicare Advantage, also known as Part C, is an alternate Medicare-approved plan from a private company.

When you first sign up for Medicare and during certain times of the year, you can choose which way to get your Medicare coverage.

“I think one of the biggest myths is that your plan is always going to stay the same," Friend said. "When you receive your information every year, which is happening now, then what happens is that you kind of look at the premium and you look at your copay to your primary care and think, 'I'm OK.'"

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However, you really need to look deeper at specifics.

What’s the co-pay for a specialist you might need? Hospitalization? Labs?

“Especially after the last two years, we’ve kind of realized that we have to expect the unexpected,” Friend said. “So, it’s important to understand; what is the co-pay to my doctor? My hospital? My lab?”

Next, find out how big the network is. How many providers do you have in your plan?

“The idea is the more providers you have, the better access to care you’re going to get,” Friend said.

There is a lot more to Medicare than there once was, everything from dental and alternative care to hearing aids and gym memberships, but don’t get overwhelmed or distracted by the extras.

“When you look at everything you want to not just look at all the extras that are being advertised right now because the extras don’t matter if you have a catastrophic event,” Friend said.

If you’ll soon be eligible for Medicare, you’re not alone. Friend says Medicare hasn’t peaked yet.

So, it’s good to start boning up on it now.

“The baby boomers are aging and there’s still a couple more years before Medicare peaks,” Friend said. “You need to find your adviser soon because there’s not as many advisers out there.”

Meanwhile, younger generations wonder if Medicare will be there for their senior years. Friend is optimistic.

“Whether it looks like what it does now or in 10 or 15 or 20 years – it looks totally different: there will be something there,” Friend said.  

For more information visit Medicare.gov.

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