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How to Choose Medicare Coverage When You Have Multiple Chronic Conditions

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How to Choose Medicare Coverage When You Have Multiple Chronic Conditions

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Updated: May 23, 2017    Published: May 19, 2017

How to Choose Medicare Coverage When You Have Multiple Chronic Conditions
Image: Costculator

Nearly three-fourths of those on Medicare in the United States suffer from multiple chronic conditions.

Chronic conditions are health conditions that last over a year and require ongoing medical treatment. In the United States, for every 1,000 people on Medicare, almost 700 of them have at least two chronic conditions and more than 350 of those people suffer from four or more long-term chronic health problems.

When it comes down to easing the management of these chronic conditions, it comes down to choosing the right Medicare options. Choosing the wrong coverage can prove devastating – especially financially. Often, you’ll find yourself selecting a Medicare Advantage plan or a Medigap policy to give you the additional accessibility and flexibility to help manage your multiple chronic conditions.

Why Do So Many Americans Have Multiple Health Problems?

There are numerous factors that go into why many aging Americans have several chronic conditions:

  • Declining Birth Rate: The U.S. birth rate has slowed. This has led to an increasingly aging population – with seniors comprising the fastest growing segment of our overall population.
  • Longer Life Expectancy: Due to advances in public health and medicine, American life expectancy has expanded. While it’s great that doctors are keeping us alive longer, this also gives us more time to accumulate ailments as we age.
  • Other Trending Factors: There is a high occurrence of life-style factors that increase the risk of chronic conditions, like poor diet, weight gain, physical inactivity and tobacco use.

Most Common Chronic Health Conditions Among Medicare Recipients

As a person’s number of chronic conditions increases, he or she is more likely to: 1.) face higher risk of hospitalization; 2.) receive conflicting advice from health care providers; and 3.) die prematurely. Those currently covered under Medicare have myriad chronic conditions, but these are the most common.

  • Asthma, chronic obstructive pulmonary disease (COPD);
  • Heart disease, atrial fibrillation, high blood pressure, cholesterol problems, stroke;
  • Diabetes, chronic kidney disease;
  • Alzheimer’s, dementia;
  • Arthritis, osteoporosis;
  • Depression; and
  • Cancer.

Medicare Coverage Benefits or Features to Look for If You Have Multiple Chronic Conditions

If you have multiple chronic conditions, the following features in Medicare coverage will serve you well:

1. Extensive Access to Doctors

You need access to the specialists who treat your chronic conditions. You might not want your general practitioner managing your high blood pressure if your endocrinologist, who treats your diabetes, wants you to see an internist for your blood pressure issues. Make sure to look over the lists of doctors and health care providers and make sure that you have extensive access per your Medicare coverage. For Original Medicare, you can check on Medicare’s website. If you’re looking at Medicare Advantage or Medigap plans, check with those specific insurers and make sure they provide the right amount of accessibility to the specialists you need.

2. Increased Flexibility

Many seniors spend several weeks or months far away from home each year. While most PPOs and HMOs give you cross-country emergency room coverage for a small copay per visit, it’s better to have greater flexibility. Consider looking into Medicare Advantage or Medigap policies that give you greater flexibility so you’re able to treat your chronic conditions away from home.

3. Mail Order Prescription Service

You might save some money, and the extra convenience is nice to have when you manage multiple prescriptions.

4. Dental and Vision Coverage

This is usually non-existent, or very small, on most Medicare plans. But some plans let you buy more dental and vision coverage at very low prices. That’s good if you have some major dental work coming up soon. Even better, you can purchase the extra coverage at any time throughout the year. You don’t have to wait until October, when Medicare’s annual enrollment season begins.

5. Extensive Pharmacy Network

Pharmacy availability is important when you have multiple chronic conditions. Look at the pharmacy list on your insurer’s website. The greater the number of pharmacies nationwide, the better chance you have of always finding an in-network pharmacy.

6. 24-Hour Medical Helpline

It’s a nice feature to have. Why? You can get instant answers to your questions on medicines and other health issues. Suppose that pizza you had at your grandson’s birthday party aggravated your ulcer or your acid reflux condition. Will that over-the-counter antacid you are about to take react with the blood thinner you take for heart disease?

7. A Personal Insurance Agent

Is there someone you can call, text or email for help with Medicare issues as they arise? The personal touch is valuable, but as an agent, of course, I have a biased opinion. It’s always nice to hear from my clients.

8. Free Gym Memberships

Programs like SilverSneakers are provided by many different health plans. You can stay fit and, more importantly, meet other seniors who share common interests with you. Don’t overlook the emotional benefits of friendship in taking care of your health. Managing multiple chronic health conditions can be discouraging, hence the prevalence of depression among seniors. Meet some new people, and make some new friends who can relate to your issues.

9. A Plan That Fits Your Overall Budget

The lowest-priced insurance policy doesn’t guarantee the lowest total out-of-pocket expenses for you. Make sure to look at things like copays and deductibles.

Communication Among Your Health Providers Is Key

All your doctors might accept your Medicare policy, but that doesn’t mean they automatically share your health information with each other. Many doctors have said they don’t receive notice when their patients are in an emergency room, are admitted to a hospital, or are discharged from a hospital. That can lead to a lack of follow-up care from their personal doctors – the ones who know them best. For people who have multiple chronic conditions, that lack of care can be a real problem.

Likewise, establishing communication among every health provider who writes prescriptions for you can also be difficult. That can lead to conflicting medicines being prescribed. Family members and caregivers, too, need to be kept in the information loop.

Since communication is key, Medicare recipients need to take a more active role in managing their chronic conditions. That effort includes fostering better communication among health providers.

Some Medicare Plans Share More Patient Information Than Others

Let’s look at two extreme examples. Suppose a person visits specialists who practice out-of-state, and the specialists are members of entirely different health care organizations. If the patient has a Medigap policy to cover his expenses, there will be no automatic sharing of his health information among providers. The patient must request, in writing, that each doctor send his medical records to his other providers. Without his written request, it won’t happen.

On the other hand, let’s say that person is a member of a Medicare HMO, and that his HMO is not local, but has providers across several states. That happens because HMOs are big organizations these days. Yes, unlike the Medigap policy owner, he will need referrals to see his specialists, but each doctor is more likely to have automatic access to his health records from the other providers within that HMO. The same might possibly be true if he has a PPO plan, and manages to see only specialists that are in-network for that plan.

Need More Help?

Read our Medicare 101 guide to get more information on how to find the right Medicare coverage to help you manage your multiple chronic conditions.

The views expressed here are those of the author and do not necessarily represent or reflect the views of Healthcare, Inc. and HealthCare.com.

Have a personal healthcare story to share? Write a brief summary of what you’d like to share and email us at stories@healthcare.com. From there, we’ll make sure to follow-up and set-up an interview.

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