Dear Savvy Senior,

  I will be 65 and eligible for Medicare in a few months and am interested in getting a Medicare Advantage plan to cover my health care and medications. What tips can you provide to help me pick a plan?

         Ready to Retire

  Dear Ready,

  Medicare Advantage plans have become very popular among retirees over the past 15 years, as nearly half of all new Medicare enrollees are signing up for Advantage plans, which accounts for about 42 percent of the entire Medicare market. Here are some tips and tools to help you pick a plan that fits your needs.

  First, let’s start with a quick review. Medicare Advantage plans (also known as Medicare Part C) are government approved health plans sold by private insurance companies that you can choose in place of original Medicare. The vast majority of Advantage plans are managed-care policies such as HMOs or PPOs that require you to get your care within a network of doctors.

  If you join an Advantage plan, the plan will provide all of your Part A (hospital insurance) and Part B (medical insurance) coverage like original Medicare does. But many plans also offer extra benefits like dental, hearing and vision coverage along with gym/fitness memberships, and most plans include prescription drug coverage too.

   Medicare Advantage plans are also cheaper than if you got original Medicare, plus a separate Part D drug plan and a Medigap policy. Many Advantage plans have $0 or low monthly premiums and don’t always have a deductible, but they also typically have a high out-of-pocket maximum. In 2021, Advantage plan participants on average were responsible for a maximum of around $5,100 for in-network care, and about $9,200 when out-of-network care is included.

How to Choose

  To help you pick a plan, a good first step is to call the office managers of the doctors you use and find out which Advantage plans they accept, and which ones they recommend. Then go to the Medicare Plan Finder tool at Medicare.gov/plan-compare to compare Advantage plans in your area. This tool provides a five-star rating system that evaluates each plan based on past customer satisfaction and quality of care the plan delivers. When comparing, here are some key points to consider:

   Total costs: Look at the plan’s entire pricing package, not just the premiums and deductibles. Compare the maximum out-of-pocket costs plus the copays and coinsurance charged for doctor office visits, hospital stays, visits to specialists, prescription drugs and other medical services. This is important because if you choose an Advantage plan, you’re not allowed to purchase a Medigap policy, which means you’ll be responsible for paying these expenses out of your own pocket.

   Drug coverage: Check the plan’s formulary – the list of prescription drugs covered – to be sure all the medications you take are covered without excessive co-pays or requirements that you try less expensive drugs first.

   Dental, vision and hearing: Many Advantage plans come with dental, vision and hearing benefits, but are usually limited. Get the details on what exactly is covered.

  Coverage away from home: Most Advantage plans limit you to using in-network doctors only within a service area or geographic region, so find out what’s covered if you need medical care when you’re away from home.

  Out-of-network coverage: Check to see what’s covered if you want to see a specialist in a hospital that is not in a plan’s network. You can get a list of doctors and hospitals that take part in a plan on the plan’s website.

Need Help?

  If you need help choosing a plan, contact your State Health Insurance Assistance Program at ShipHelp.org or call 877-839-2675. Also see the HealthMetrix Research 2022 Cost Comparisons Report at MedicareNewsWatch.com that lists the best Advantage plans based on health status.

  Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

Savvy Senior

A Common Heart Problem That’s Often Ignored

  Dear Savvy Senior,

  What can you tell me about atrial fibrillation? Every so often, I’ve noticed my heart starts beating rapidly for no particular reason. Is this something I should be worried about?

   Anxious Annie

  Dear Annie,

  Heart palpitations can be harmless if they are brief and infrequent. But if you’re experiencing an erratic heart rhythm, you need to get checked out by a doctor for atrial fibrillation, or AFib.

  AFib – which is marked by rapid, fluttering beats – can lead to serious complications such as stroke and heart failure, when the weakened heart can’t pump enough blood to the rest of the body.

  Normally, your heartbeat follows a steady rhythm as your heart contracts and relaxes. But when you have AFib, the upper chambers of your heart (atria) beat rapidly and irregularly, sending blood to the lower chambers (ventricles) less efficiently. These episodes can last for minutes to hours or longer, and can cause palpitations, lightheadedness, fatigue, and/or shortness of breath. Over time, AFib tends to become chronic.

  Age is a common risk factor for AFib, which affects roughly 10 percent of people older than 75. Other factors include genetics, obesity, diabetes, high blood pressure, and alcohol and tobacco use. The condition has also been linked to viral infections, including COVID-19.

Diagnosing AFib

  If you’re experiencing AFib-like symptoms you need to see your doctor who will listen to your heart and likely recommend an electrocardiogram (EKG) or a treadmill heart test, or you may wear a portable monitor for several weeks to look for abnormal heart rhythms to confirm a diagnosis of AFib. Such tests can help distinguish AFib from less serious conditions that may cause the heart to flutter, like anxiety and stress.

  AFib affects some three million adults in the United States, a number that is expected to quadruple in the coming decade as the population ages and risk factors like obesity, diabetes and high blood pressure become even more common. The lifetime risk of developing AFib is greater than 20 percent, yet many people don’t even know they have it.

Treatment Options

  A growing body of research underscores the importance of lifestyle steps such as exercise, a healthy diet, and limiting alcohol for treating AFib.

  Depending on your age and symptoms, your doctor may prescribe drugs to help control your heart rate, like beta blockers such as metoprolol (Toprol XL); and/or rhythm, such as antiarrhythmics like flecainide (Tambocor).

  You may also need an electrical cardioversion, an outpatient procedure that delivers an electrical shock to the heart to restore a normal rhythm. You will be sedated for this brief procedure and not feel the shocks.

  Catheter ablation is another outpatient treatment for AFib that scars a small area of heart tissue that causes irregular heartbeats. This procedure is becoming more common based on evidence of its safety and ability to normalize the heart rhythm and ease symptoms. Ablations can be effective in people 75 and older, but medication may still be required afterward.

  If you’re at higher risk for stroke, you may be prescribed a blood thinner, too. In the past, Coumadin (warfarin) was the only such drug widely available, but it requires monitoring with regular blood tests. Newer anticoagulants, like apixaban (Eliquis) and rivaroxaban (Xarelto), don’t have that requirement and have been shown to be just as effective at preventing strokes.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.