Question: What should I do with my insurance coverage? I have Medicare and a Medicare Advantage Plan. My doctor is running some tests and I may have some serious decisions to make in the coming weeks.

Answer: Medicare Coverage and the options available with it are very useful and comprehensive. As you move through this process it is important to understand you have opportunities to evaluate your insurance coverage and make changes that reduce your exposure to big medical costs.

I have talked often about Enrollment Periods, which are the periods of time that you are allowed to change your insurance choices. You currently have a Medicare Advantage Plan which allows you to switch to any alternative coverage of your choice from Jan. 1 to March 31 each year, known as the Medicare Advantage Plan Open Enrollment Period (MA-OEP).

When you have a Medicare Advantage Plan, you have useful insurance. That insurance can cover the tests and appointments you are getting done as long as you go through the prior approval process. A Medicare Advantage Plan usually has co-pays for each test, procedure, and appointment. You want to be thinking about what you are having done and where you are having it done. You must consider your network to be assured of effective coverage. You also need to be aware of the costs of the tests, procedures, and appointments.

Medicare Advantage Plans usually have inexpensive monthly premiums with co-pays and deductibles for most tests, procedures and appointments.

If your situation is short in duration and then resolved, staying with your current plan could be an appropriate choice. If your situation turns out to be longer and more serious, you may choose to change your current coverage using the MA-OEP now, or later in the year using a Special Enrollment Period (SEP) to adjust your insurance to something more comprehensive. That alternative plan could be Original Medicare plus Medicare Supplement Plan plus Part D coverage. If this occurs, your premiums would probably be higher, but the cost for tests, procedures and appointments, would likely be less. If you have a serious medical problem, you may also want to go to a larger pool of providers and hospitals. Original Medicare allows to you see almost any doctor, anywhere in the country. Referrals are not usually required neither are prior approvals for testing when ordered by your physician. Knowing this information can sometimes make treating a serious illness easier to handle.

With most Medicare related changes to your insurance coverage, the start date of the new plan is on the first day of the month, following your change.

Talk with your physician, your support system and those that help with your insurance coverage to evaluate the alternatives and make a change if that makes sense for you.

Insurance can be adjusted in many ways to better address what is happening in your life.

The change you make may be repeated as other enrollment periods and SEPs happen.

Your Medicare insurance coverage should be adjusted as your situation changes.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call us at 720-9797 or e-mail at SLM@lutheran-jamestown.org.