How to Choose a Medicare Plan
Key Points
How to Choose a Medicare Plan
Choosing a Medicare plan can feel overwhelming, especially if you’re new to the world of insurance. I’ll walk you through the basics of how to choose a Medicare plan, the different types of plans available, and how to choose the best one for your needs.
Understanding Medicare Basics
What is Medicare?
Medicare is a federal health insurance program primarily for people aged 65 and older, but it also covers certain younger individuals with disabilities and those with End-Stage Renal Disease. Medicare is designed to help cover many of the medical costs that can add up as we age.
Different Parts of Medicare
Medicare is divided into four parts, each covering different aspects of healthcare:
- Part A (Hospital Insurance): This covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
- Part B (Medical Insurance): This covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
- Part C (Medicare Advantage): These are private insurance plans that provide all Part A and Part B benefits and often include additional benefits like vision, dental, and hearing.
- Part D (Prescription Drug Coverage): This helps cover the cost of prescription drugs.
Original Medicare vs. Medicare Advantage
Original Medicare
Original Medicare consists of Part A and Part B. With Original Medicare, you can visit any doctor or hospital that accepts Medicare, and you don’t need a referral to see a specialist. However, there are costs involved, such as deductibles and coinsurance, and it doesn’t cover everything—like most dental, vision, and hearing care.
Medicare Advantage
Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare. These plans cover everything Original Medicare does but often include additional benefits like dental, vision, and wellness programs. They may also have different costs and restrictions, such as network limitations where you can only see certain doctors and specialists.
Prescription Drug Coverage (Part D)
Importance of Part D
Prescription drugs can be a significant expense, especially as we get older and our medical needs increase. That’s why Part D is so important. It helps cover the cost of medications, making them more affordable and accessible.
How to Choose a Part D Plan
When choosing a Part D plan, consider the following:
- Formulary: This is the list of covered drugs. Make sure the medications you take are included.
- Pharmacy Network: Check if your preferred pharmacy is in the plan’s network.
- Costs: Compare premiums, deductibles, and copayments to find a plan that fits your budget.
Medigap (Supplemental Insurance)
What is Medigap?
Medigap, also known as Medicare Supplement Insurance, helps fill the “gaps” in Original Medicare. These standardized plans are offered by private companies and can help cover out-of-pocket costs like copayments, coinsurance, and deductibles.
How Medigap Works with Original Medicare
Medigap policies work alongside your Original Medicare coverage. When you receive healthcare services, Medicare pays its share of the approved amount, and then your Medigap policy pays its share. This can significantly reduce your out-of-pocket expenses.
Key Factors to Consider When Choosing a Plan
Health Needs and Current Medications
One of the first things to consider is your health needs and the medications you take. Different plans cover different drugs and services, so you’ll want a plan that matches your specific health requirements.
Budget and Costs
Medicare plans come with various costs, including premiums, deductibles, and copayments. It’s important to choose a plan that fits within your budget. Remember, the cheapest plan isn’t always the best—it’s about finding the best value for your money.
Preferred Doctors and Hospitals
If you have preferred doctors or hospitals, check if they accept the Medicare plan you’re considering. This is especially important with Medicare Advantage plans, which often have network restrictions.
Additional Benefits
Some Medicare Advantage plans offer extra benefits like dental, vision, and hearing coverage. If these are important to you, look for plans that include these services.
Travel and Coverage Area
If you travel frequently, consider how your Medicare plan will cover you while you’re away from home. Original Medicare along with MediGap plans offers nationwide coverage, but some Medicare Advantage plans may have more limited networks.
Steps to Choose the Right Medicare Plan
Step 1: Assess Your Health Care Needs
Start by making a list of your current health conditions, medications, and any upcoming medical procedures. This will help you identify which benefits are most important to you.
Step 2: Compare Plan Options
Use Medicare’s Plan Finder tool to compare different plans available in your area. This tool allows you to input your specific needs and preferences to find plans that match.
Step 3: Consider Total Costs
Look beyond the monthly premium. Consider all costs, including deductibles, copayments, and out-of-pocket maximums. This will give you a clearer picture of your potential expenses.
Step 4: Check the Plan’s Network
Ensure your preferred doctors and hospitals are included in the plan’s network. If not, you might have to switch providers or pay more out-of-pocket.
Step 5: Evaluate Additional Benefits
Consider any additional benefits offered by the plan, such as dental, vision, or wellness programs. These can add significant value, especially if they cover services you regularly use.
Step 6: Seek Professional Help if Needed
If you’re feeling overwhelmed, don’t hesitate to consult with a licensed insurance representative. They can provide personalized advice and help you navigate the complex world of Medicare.
Common Pitfalls to Avoid
Not Reviewing Annual Changes in Plans
Medicare plans can change annually. Make it a habit to review your plan each year during the open enrollment period to ensure it still meets your needs.
Ignoring Out-of-Pocket Costs
Low premiums can be attractive, but they often come with higher out-of-pocket costs. Always consider the total cost of the plan, not just the premium.
Overlooking Network Restrictions
Especially with Medicare Advantage plans, make sure your preferred providers are in the network. Out-of-network care can be significantly more expensive.
Not Considering Future Health Needs
While it’s important to consider your current health needs, try to anticipate future needs as well. Choose a plan that can accommodate potential changes in your health.
Choosing the right Medicare plan is a crucial decision that can impact your health and finances. Take the time to assess your needs, compare your options, and consider all costs involved. With careful planning and the right information, you can find a Medicare plan that provides the coverage and peace of mind you deserve.
Helpful Tips
You can sign up for one of our free New to Medicare webinars. Ron Morales, goes over all the basics of Medicare in plain and simple terms. You can attend right from your home or office computer. The webinars last about an hour, and she stays to answer your questions afterward.
You can visit our blog post about Medicare Advantage plans vs. Medicare Supplements (Medigap). We have a handy guide that you can download there to read later on. There are a lot of great tips here about how to choose a Medicare plan that fits you. Additionally, if you are more of the snowbird type, visit this blog on what snowbirds may consider for coverage.
Once you’ve decided which route works best for you, then you can move on to quotes from insurance companies.