How to Choose a Medicare Plan | Medicare Planning of America

Trying to decide the type of Medicare coverage you need can sometimes be very confusing, especially for those who haven’t had to deal with this before and those who need a different scope of coverage than they had in the past. Trying to sort through the available options can be time-consuming if you aren’t looking in the right place for coverage options.

Ensuring you have the right care has several benefits. It enables you to ensure you get the medical care you need. It also helps to ensure you’re going to be able to handle the financial responsibilities that come with getting that care.

Making the choice of what Medicare plan to choose has to take your finances, specific health conditions, and the need for prescription drug coverage into account. Because of this, a plan that works for a loved one or friend might not be the best one for you. Choosing a Medicare plan is an individual decision that must be considered carefully. Use this information to guide you as you make your decision about what Medicare plan you’re going to use for the upcoming year.

What Is Medicare?

Medicare is the health insurance program that’s handled through the federal government. It’s available for very specific demographics of individuals. These include:

People who are at least 65 years old
Disabled individuals younger than 65 if they meet certain criteria
Individuals who have end-stage renal disease

People who are eligible to receive medical insurance have two options to choose from. They can enroll in Original Medicare through the government, or they can opt into a Medicare Advantage plan through private insurers. There are distinct differences between these.

Once you make a determination about which option is right for you, you’ll have to stay with it until the next open enrollment period. Open enrollment, which typically runs from October 15 to December 7 each year, is a time when you can change the plans you’re enrolled in.

There are four parts to the Medicare program. These options are designated according to the type of coverage they provide enrollees.

Part A

This is coverage for inpatient hospital stays, hospice, and skilled nursing care. It also covers limited home health care.

Part C

This is known as Medicare Advantage.

Part B

This covers specific outpatient, doctor, and preventive care. It also covers some medical supplies.

Part D

This is the prescription drug coverage for the medications you take. It also offers coverage for many vaccinations.

What Do I Need to Know About Medicare Part D Coverage?

Part D plans, which is the prescription drug plan, vary greatly. When you’re considering these plans, you need to look at how they interact with the medical conditions you have. If you know which medications you’ll need on a regular basis, you can find out how they’re covered by specific plans.

There are specific standards these plans must meet. For example, they typically cover name brand and generic drugs; however, your co-payment will likely be vastly different for a name brand than it would for a generic drug.

The monthly premium for these plans varies. You’ll have to look into how the premiums compare with the savings you’ll receive for the medications you take on a regular basis. Remember to include the deductible in this cost-saving determination. Some plans don’t have a deductible, but others do. You have to pay the equivalent of the deductible on your medications before the plan will kick in.

What Is a Medicare Advantage Plan?

A Medicare Advantage plan, also known as Part C, is coverage that goes through a private insurance company instead of directly through the federal government.

By law, these plans must cover at least what the Original Medicare plans cover, but many of them cover more things, so they’re likely a good idea for most individuals on Medicare.

Some of the extra benefits these plans cover may include: (source)

Transportation to doctor visits
Vision care
Hearing care
Dental care

Wellness programs
Gym memberships
Over-the-counter medications
Adult daycare services

Remember, these extra benefits vary from one plan to the next. If there are any you want to have in your coverage, you’ll have to review the plans carefully to determine whether they’re included.

Another factor you may want to review before you decide on a specific plan is how they handle appeals. This is important because you never know when you’re going to need care, medications, equipment, or services that are denied coverage. Understanding the appeal process is important.

You should also ensure you know the process for preapprovals. These can sometimes save you from having to go through the appeals process because they enable you to get approval for what you need ahead of time. This is helpful if you know you’re going to need surgery and your doctor is ready to proceed. Some medications, procedures, and other services require you to get a preapproval.

What Is Medigap Coverage?

Medigap is a special type of private insurance that helps to cover the costs of things that aren’t covered by Medicare Part A and Part B. This coverage is only appropriate for individuals who don’t have a Medicare Advantage plan. The Medigap policy won’t payout if you have a Medicare Advantage plan, so you can drop that coverage once your Medicare Advantage plan becomes active.

What Factors Should You Look at When Choosing Your Medicare Plan?

There are several primary factors you have to consider when you’re looking at Medicare plans. These include: (source: Medicare.gov)

The Cost of Coverage and Care

Original Medicare plans don’t have a maximum out-of-pocket cost for any year. This means you’ll be responsible for any deductibles or co-pays without any cap for any medical care you receive.

Medicare Advantage plans usually have annual maximum out-of-pocket costs. The out-of-pocket costs you incur will vary according to your plan. This is often a cost-effective option for people who know they’re going to have considerable amounts of covered medical care costs each year.

If you take prescription medications, the cost of obtaining these should be factored into your decision about a Part D plan. You’ll need to review the formulary for the plans you’re considering, if possible. The formulary outlines what drugs they’ll pay for, how much of a co-pay you’ll have, and whether there are any requirements for getting the drugs covered. If you’re looking into Medicare Advantage plans, find out if the ones on your shortlist provide prescription drug coverage, because some do have this option.

Impact of Supplemental Coverage

Some people have supplemental coverage policies. Find out how these will work with your Medicare plan options. Sometimes the supplemental policies don’t work with Medicare Advantage plans. It’s best to ask about how they will interact with your coverage so you aren’t paying for a useless policy.

Some types of medical care might be rather challenging to determine coverage for when you’re exploring your options. Many Medicare Advantage plans include vision, dental and hearing coverage. Others don’t do this. If you’re interested in these, find out exactly what’s covered in the plans you’re considering.

Where You Plan to Travel

Most Medicare plans will offer coverage throughout the United States; however, you aren’t likely going to find plans that offer coverage that extends to international trips. If this is a consideration for you, it might be necessary to find travel policies for health coverage in the areas in which you plan to travel. You need to plan for how you’ll handle the cost of an emergency or urgent medical need.

Doctors, Hospitals and Centers in the Plan’s Network

People who are on Original Medicare can seek care anywhere that accepts Medicare. Those who are interested in a Medicare Advantage plan need to look closely at where they can seek care. These plans have provider networks, so you’ll have to seek care within the network if you want to reap maximum benefits.

If you plan on seeking care outside the network, you should find out how this will be covered. Some Medicare Advantage plans offer out-of-network coverage, but others don’t extend this to the plan’s members. It’s a good idea to find out about the out-of-network coverage if you plan on traveling away from your home. You never know when a medical emergency will happen, so you might have to seek care away from the network if you have an emergency.

How Can You Sign up for a Medicare Plan?

When you’re ready to choose your Medicare coverage, you can compare plans you’re eligible for on our website or contact us at 888-241-1470 to get started. The Medicare Planning of America team is ready to help you go through your coverage needs and find a policy that can meet those needs. Just give us a call and we can help you find the plan that fits your life.

We understand this is a major decision. We want to ensure you don’t get stuck having to make a hasty decision. Our professional team members are standing by to help you find the best plan for your needs.