The health care decisions you make have a big impact on your life and your wallet.

Today, you may have more options than ever before, and the annual election period for Medicare, which started on Nov. 15, is the time to explore your choices and enroll in a plan.

In addition to enrolling in the right plan, there are ways to get the most value from your plan once you have enrolled. Just knowing how to use your health plan and communicating with your doctor may help.


Health insurance plans can be complicated, but the more you know about yours, the more cost-effectively you may be able to use it. To do so:

Know your benefits: Reading your plan’s information and any updates as they arrive may help you understand which services are covered — as well as any limitations, exclusions and maximum payments. You will learn about available preventive services and any annual programs that are included in your plan.

Find out how much you have to pay: Health plans typically ask you to pay a portion of your health care costs — in the form of monthly premiums, coinsurance, deductibles, and co-payments. Use your plan benefits wisely to save on out-of-pocket expenses.

For example, if you have a Medicare Advantage HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) plan, choosing in-network providers (doctors and hospitals) may help lower your costs.

Keep in mind that an HMO plan may require you to stay in network while a PPO plan allows you to go outside the network, usually at additional costs.

Learn how to get coverage: Follow your plan’s guidelines for seeing a doctor or specialist, being admitted to a hospital, getting a second opinion or having a screening test.

Know where to find information: Look in your plan materials or on your health plan’s website. There, you may be able to find information on who to call to ask questions, get a referral or seek advice.


Talk with your doctor about your health care needs and which plan may be right for you.

When choosing the appropriate plan, you should weigh a variety of factors, including your overall health, any chronic conditions you are managing and, of course, cost.

It’s important for people with Medicare to know what is available to them.

Beyond choosing a plan, it’s important to ask the right questions and take advantage of benefits offered by your plan. Consider these tips:

Know who to call when you have questions: Can you ask a nurse or doctor routine questions over the phone, or do you need to make an appointment? Does your health plan provide a health hotline?

Prevention is key: It’s important to see a doctor when you are healthy to have a baseline. Keep up with wellness check-ups, immunizations and preventive screenings so you stay healthy.

Prepare for office visits: Give your doctor the information he or she may need to make a diagnosis — for example, medical records and a list of all medications you take.

Learn about your condition and treatment options: You can get information from your doctor and from organizations, such as the American Heart Association, to help manage chronic diseases. Your doctor and health plan also may recommend reliable resources and services.

Ask about less costly treatments: For example, if your doctor prescribes a brand-name medication, ask whether a generic alternative would be appropriate.

Keeping your health care costs down can be as simple as familiarizing yourself with the terms of your health plan and then asking the right person the right questions.


– Special to The Press Herald