Phil Moeller: Making the most of your Medicare plan
Written by Phil Moeller, UnitedHealthcare contributor, Medicare and Retirement expert
This time of year can bring warmer weather, gardening and golf, and lots more. Odds are, however, that it seldom triggers the urge to think about your 2025 Medicare coverage.
By now, you may already have met your annual deductible for Part B, which covers medical services.
And, you’ve likely used your Part D benefit and filled some prescriptions. There’s a new $2,000 out-of-pocket maximum on annual prescription drug costs, meaning you should never have to pay more than $2,000. This includes any copays, coinsurance, and annual deductibles; it does not include your Part D premiums.
If you have been ill or in need of medical care, you’re either better or getting treatment. In the process, you’ve figured out what’s covered, whether by a Medicare Advantage plan or Original Medicare, perhaps with a Medicare Supplement (Medigap) plan.
You’re pretty much set for the year, right?
No! You’re only set for the health care needs you know about.
What about medical challenges you haven’t yet confronted? Or all the things your insurance plan covers that you may not know about?
Medicare has an extensive program of covered preventive health services, a list of roughly three dozen services that are covered by your Medicare plan.1 It’s a comprehensive list for a good reason. As we age, things tend to stop working. And if we had to pay for preventive care, well, the odds are high we would go without it.
While the numbers have changed since 2022, the logic that prevention is a priority has not. Here are a few data points from my 2022 book, “Get What’s Yours for Health Care”:
“Roughly 30 million people in the United States have high blood pressure, 25 million have high cholesterol, 10 million have diabetes. These conditions are relatively easy to treat if people know about them and act. Many don’t. If they did seek preventive care, we could prevent 650,000 annual cardiovascular deaths, up to 150,000 stroke deaths, and 80,000 deaths from type 2 diabetes. Flu killed 80,000 in 2018 yet fewer than 50% of Americans get annual flu vaccines.”
Where might you begin your preventive health care journey?
Beyond an annual physical, which many Medicare plans cover, Medicare’s annual wellness visit is a great place to start. Sitting down with your primary care provider, you can discuss which preventive and screening services make sense given your health profile. This is not a physical exam but a planning session at no cost. Just be careful to set ground rules with your health provider to avoid expanding the parameters of the meeting into something for which you are billed. Fewer than half of Medicare beneficiaries use this benefit.2
Immunizations should be next on your to-do list. Measles outbreaks in parts of the U.S. have been a wake-up call to get proven and effective protection. Four of these shots are covered by Part B of Medicare: COVID-19 vaccines, Flu shots, Hepatitis B shots, and Pneumococcal shots.
Part D drug plans cover the following, but be sure to discuss with your provider to determine which vaccines are right for you.
- RSV vaccine (Respiratory syncytial virus): A one-time vaccine given in one shot
- Shingles vaccine: A one-time vaccine given in two shots over two to six months
- Tdap vaccine (tetanus, diphtheria and pertussis/whooping cough): One shot if you’ve never been vaccinated, and a booster every 10 years
- MMR vaccine (which protects against measles, mumps, and rubella): Two shots are normally prescribed for lifetime protection
- Others: Vaccines that are "reasonable and necessary" to prevent illness and are not covered by Part B
Many Part D immunizations are available at $0. Check with your plan for details.
If you have a Medicare Advantage plan, as more than half of all Medicare enrollees do, now is also a great time to review its additional benefits outside of medical and prescription drug coverage. These benefits are sometimes called “ancillary benefits” and include coverage of routine dental, hearing, and vision care. Plans usually also offer free gym memberships. Check with your plan to see details plus other benefits not mentioned here.
Original Medicare does not cover these ancillary benefits. If you have Original Medicare and a Medigap plan, check with your Medigap insurer to see if it covers fitness memberships or other ancillary benefits. Some plans do.
With apologies for being so pushy, my last request of you is to make sure you have access to a comprehensive set of your medical records before deciding on the care that makes the most sense for you. Whether 10% or 90% of people your age should have a certain test is beside the point here. The issue is which tests make the most sense for you. This brings us full circle back to why a wellness discussion with your primary care provider is such a good idea.
As seasons change, make sure you are making the most of your Medicare plan.
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Author bio
Philip Moeller is the principal author of the Get What’s Yours series of books about Social Security, Medicare, and health care. Read his Substack newsletter and connect with him on LinkedIn.