Written by Jennifer Kleinhans
Article
Fall brings sweater weather, pumpkin everything, and…Medicare commercials. So. Many. Medicare. Commercials.
As HARTZ PT’s billing manager, I know insurance probably isn’t your favorite topic. You’d rather be enjoying the season than comparing copays. I get it!
But a little homework now can help you choose coverage that fits your health, your budget, and the providers you love.
Grab a cup of coffee. Let’s make this easier.
First, circle December 7
Medicare Open Enrollment runs October 15 through December 7, with changes taking effect January 1. It’s your opportunity to review your Medicare Advantage or prescription drug coverage and make eligible changes for the coming year.
Before you choose, here are five questions I’d put at the top of your list.
1. “Can I keep my people?”
Your doctor. Your specialists. Your physical therapist who knows exactly what you mean when you say, “That knee is doing that thing again.”
With Original Medicare, you can generally see providers who accept Medicare. Medicare Advantage plans may have networks that affect where you can go and what you pay.
Check the exact plan—not just the insurance company’s name—with both the insurer and your providers. Two plans from the same company can work differently.
If continuing care at HARTZ PT matters to you, put us on your checklist!
2. “What will I pay when I actually use it?”
A low monthly premium can catch your eye. But it’s only one piece of the picture.
Look at deductibles, copays, coinsurance, and any applicable annual out-of-pocket limit. Think about the care you may need throughout the year—not just the monthly price.
Here’s an easy example: If a plan charges $35 per PT visit, 12 visits would mean $420 in copays. That’s a made-up example, but it shows why the details deserve a closer look.
3. “How does this plan handle physical therapy?”
Whether you’re planning a joint replacement or working on strength and balance, ask:
What would I pay for each outpatient PT visit?
Is my preferred clinic in network?
Does the plan require a referral?
Does treatment need approval from the insurance company first?
Some Medicare Advantage plans require referrals or prior authorization for certain services. Knowing the rules ahead of time helps you understand the steps involved in getting care.
4. “Does it fit the rest of my life?”
PT is one piece of your healthcare puzzle. Check your prescriptions, preferred pharmacy, specialists, and coverage when you travel, too.
Your neighbor may love their plan. Your neighbor may also take different medications, see different doctors, and spend January somewhere considerably warmer.
Their perfect fit may look different from yours.
You can compare Medicare health and drug plans at Medicare.gov.
5. “Who can help me sort this out?”
You don’t have to figure everything out at the kitchen table by yourself.
Here in Pennsylvania, PA MEDI offers free, unbiased Medicare counseling to help you understand and compare your options. Call 1-800-783-7067 for assistance.
Thinking about switching from Medicare Advantage to Original Medicare and adding a supplement? Ask about Medigap eligibility before making the change. Fall Open Enrollment does not automatically guarantee you can buy a Medigap policy.
A little homework. A lot more confidence.
You don’t need to become an insurance expert. Just start with three things: your providers, your costs, and the care you expect to need.
And before you click “enroll,” give our billing team a call with the exact plan name you’re considering. We can help you check HARTZ PT’s participation and understand the PT benefit questions to ask.
Your health deserves a little fine-print attention—and a friendly person to help you through it.
Warmly,
Jen