New changes in Medicare: what you should know – La Opinion

The Biden administration is proposing changes to private Medicare insurance plans aimed at improving care and benefits for seniors. These changes include:

  1. Greater visibility of additional benefits: The administration is working to ensure that additional benefits offered by Medicare Advantage plans, such as vision exams, dental and fitness benefits, are used more effectively. Insurance companies will have to remind seniors throughout the year what benefits are available and how to access them. By doing so, they try to prevent these benefits from being used primarily as a marketing strategy.
  2. Increased regulation of agents and brokers: As many seniors turn to agents or brokers to choose a Medicare Advantage plan, the administration is trying to create better barriers to ensure these brokers act in the best interests of seniors. It also seeks to limit the influence of large insurance companies that offer incentives to agents to steer seniors to certain plans.
  3. Expanding Behavioral Health Care: Medicare Advantage plans will need to include an adequate network of behavioral health providers, including marriage and family therapists, as well as mental health counselors. This measure seeks to improve access to mental health services for Medicare Advantage beneficiaries.
  4. Lowering drug costs: The administration is trying to give seniors faster access to more affordable versions of biologic drugs through the flexibility to replace more expensive original versions with cheaper biosimilars. It’s part of efforts to lower prescription drug prices.

These changes are subject to a 60-day comment period before final implementation. The goal is to improve care and benefits for seniors participating in Medicare Advantage plans and ensure that taxpayer dollars are used more efficiently in health care.

What we should know about Medicare

Medicare is a health insurance program in the United States that provides coverage to people over age 65, some younger people with disabilities, and people with end-stage kidney disease. The program is administered by the federal government and is divided into several parts that offer different types of coverage:

  1. Medicare Part A: Also known as hospital insurance, it covers hospital care, skilled nursing care, home care and hospice. Most people don’t have to pay premiums for Part A if they or their spouses have worked and paid Medicare taxes for at least 10 years.
  2. Medicare Part B: Known as health insurance, it covers medical services, doctor visits, lab services, x-rays and other medical services. Beneficiaries must pay a monthly premium for Part B. This part is optional, but enrollment is encouraged if eligible.
  3. Medicare Part C (Medicare Advantage): This is a private insurance program that offers an alternative to Parts A and B. Administered by Medicare-approved private insurance companies, these plans often include additional benefits such as prescription drugs, dental and vision care, and physical fitness. Medicare Advantage beneficiaries must still pay Part B premiums and, in some cases, additional premiums.
  4. Medicare Part D: This part covers the cost of prescription drugs. These plans are also offered by Medicare-approved private insurance companies. Beneficiaries must pay monthly premiums for Part D.
  5. Medigap (Medicare Supplement Plans): These private insurance plans help fill gaps in Original Medicare coverage (Parts A and B), such as deductibles and deductibles. Medicare beneficiaries who want more comprehensive coverage often purchase an additional Medigap plan.

Importantly, Medicare costs and coverage can vary by party, plan, and geographic location of the beneficiary. People usually sign up for Medicare during their initial enrollment period, which starts three months before the month they turn 65 and lasts until three months after. There are also annual and special enrollment periods in certain circumstances.

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