Champaign, Ill. (WCIA)

Simplete Local 

If you’re 65 or older you may want to listen up. The annual enrollment period for Medicare is coming and if you miss deadlines, delay enrollment or choose the wrong plan it can cost you money and access to the type of care you want. Kimberly Smith, Community Outreach Manager, is here with us today to explain what we need to know to have to make the best choices for our health and well-being in the coming year. 

Why is this time of year so important for people who are eligible for Medicare?

• We are about to enter the Medicare Annual Enrollment Period (October 15 – December 7)

• This is the time people can make changes to their plans for the upcoming year or choose to stay on their current plan

• We encourage everyone to use this time to review their current plan to assure it still fits their needs

• Good time to look at what other plans offer

• When you understand your plan options you can get the best care and coverage at a price you can afford  

Let’s start with the basics. What is Medicare?

• Federally funded health insurance program comprised of four parts referred to as A, B, C and D

• You qualify for Medicare if you are 65 years of age or older or are under 65 and have one of a select group of illnesses or disabilities

• Medicare is the primary way by which most people will meet their healthcare needs in retirement

• Most people must enroll in Medicare sometime between the three months before and after their 65th birthday month if they are not already receiving retirement or disability benefits from Social Security 

What are the primary plan choices?
 Original Medicare

• Part A and Part B together make up Original Medicare, Part C and Part D offer coverage and benefits beyond what A and B offer 

• Part A is the hospital insurance and covers inpatient hospital stays, care in skilled nursing facilities, hospice care, and some home health care

• Part B is the medical insurance and covers preventive services, certain doctor’s services, outpatient care, and some medical supplies 

• Part C is called Medicare Advantage and it’s an all-in-one alternative to Original Medicare that covers all the services you get under Original Medicare plus often includes Part D and other extra perks and programs to help keep members healthy 

• Part D is prescription drug coverage 

Medicare Advantage plan (also known as Medicare Part C)
• Similar benefits to an individual or group health insurance plan

• A comprehensive plan that bundles Part A, Part B and often Part D coverage
• Often includes additional coverage for routine vision, dental and hearing services plus extra wellness and care coordination benefits

• May also include coverage for some fitness activities and discounts for over-the-counter items 

• Participants pay their Part B premium for their Medicare

• Monthly premiums with some plans start at $0/month 

• Yearly limit on out-of-pocket costs for medical services

• Cannot be combined with Medicare Supplement/Medigap policies

• Offered and managed by private insurance companies approved by Medicare 

Are Medicare Advantage plans better than other Medicare plans?

• Selecting a Medicare plan is highly personal.

• Take time to consider what is a “have to have” and what is a “like to have” and don’t forget to look at the perks.

• Medicare Advantage plans often include additional coverage for routine vision, dental and hearing services. Simplete plans from Health Alliance also include features such as coverage for fitness activities and discounts on over-the-counter items.

• Consider the out-of-pocket costs – determine if you are more comfortable with a yearly limit on out-of-pocket costs for medical services or are you are willing to purchase supplemental insurance to help defray some out-of-pocket costs.

• People who liked the health insurance they had from their employer when they were working, might appreciate the one-stop-shopping convenience of a more comprehensive plan like the Simplete plan.

• Medicare Advantage plans like some of the ones from Simplete often meet a wide variety of budgets and clients’ needs, wants and extras.

What do Simplete members like most about their Medicare Advantage plan?

• Simpler, more complete healthcare experience

• Lower costs and less red tape thanks to a streamlined relationship with healthcare providers and insurance

• We offer plans that allow you to see any doctor or hospital that accepts Medicare

• Care coordination to meet a variety of needs

• Coverage for hospital, doctor’s office and pharmacy bundled into one plan

• Can be more affordable than Medicare Supplement 

What changes are coming for 2023?

• We are offering even more benefits, lower costs and less red tape. It’s simple and complete.

• We offer plans as low as $0 per month
 • Dental, vision and hearing coverage

• Virtual health coverage

• Over-the-counter drug discount program

• Fitness and healthy lifestyle benefit

• And speaking of dental, we are increasing the dental benefit to $2,000 per year for most of our plans.

• Plus, there are no dental networks — so you may go wherever you’d like.

• We’ve also added a Companionship Benefit which provides up to 30 hours of in-home support yearly through the Papa Pal program

o This service gives you access to a friendly companion who can help you with a variety of tasks

• These benefits help us continue our focus on keeping members healthy, not just supporting them when they are sick

How do people get more information or sign-up during Medicare Open Enrollment?

• Open enrollment runs from October 15 through December 7

• If you are around the Champaign area, visit our office at 3301 Fields South Dr., Suite #105, in southwest Champaign

• Call a Simplete representative at 1-877-634-3390

• Visit Simplete.org online 

• Contact their local agent 

What if someone is overwhelmed about even getting started? What additional support does Simplete provide?

• Whether people are personally shopping for a plan or assisting a family member with Medicare decisions, we are a phone call away and will help answer questions 

• One size does not fit all when it comes to Medicare coverage, so we are happy to help people find plans that fit their health and wellness needs and match their lifestyle  

We’ve heard that there are some changes with other Medicare plans in the market. What can you tell us about that?

• Whether your plan is changing or you’ve been notified its ending, now is the time to review your coverage. And we’re here to help. We can discuss your situation and help you find a plan that fits your needs.

• Don’t wait, it’s important that you consider all your options and take action so you continue to have coverage next year.