When deciding on a Medicare plan, the selection process can be overwhelming. However, with all the correct information, you can make an informed decision that best suits your healthcare needs and budget.
Whether you are new to Medicare or re-evaluating your current plan, it is important to know all your options and what they offer. This guide will help you navigate the Medicare maze to do what’s right for you.
For more detailed insights, check out https://boomerbenefits.com/original-medicare-vs-medicare-advantage/.
Before we discuss the specific plans, make sure you understand the basics of Medicare. Medicare is a federal health insurance program primarily for people 65 and over, but it also covers some younger people with disabilities and certain illnesses.
Medicare is divided into multiple parts:
Part A and Part B are the two main parts of Original Medicare that come from the federal government. You enroll in these through the Social Security Office.
Part A and Part B:
Part A provides coverage for your inpatient hospital stays, skilled nursing care, some home health care services, and hospice care.
Part B handles your outpatient coverage. It covers services like doctor visits, physical therapy, lab work, and outpatient surgery.
Part C (Medicare Advantage):
Medicare Advantage Plans are an alternative way to receive your Medicare benefits. Private companies approved by Medicare offer these plans.
Part D (Prescription Coverage):
Medicare Part D covers the prescriptions you’d pick up at the pharmacy. You can have a standalone Part D or Advantage plan with a built-in Part D prescription plan.
Medigap (Supplemental Insurance):
Medigap plans pay secondary to Original Medicare, which helps pay for remaining costs that Original Medicare doesn’t cover, such as copayments, coinsurance, and deductibles.
Which plan do you need?
Before choosing your Medicare plan, you want to look inward.
How often do you visit the doctor? Do you see specialists regularly? Do you have any chronic conditions that require regular care? What about prescriptions?
If you have frequent doctor visits, you might need a plan with lower copayments. If you have a certain condition, some plans may provide fuller coverage for what services you’ll need. Different prescription plans offer better coverage than others.
These are all factors to consider, so keep these in mind before enrolling in the first plan you hear about.
Comparing Medicare Plans
Once you have a clear understanding of your healthcare needs, you can start comparing different Medicare plans to get a feel of which plan type works for you. Here are some key points to consider:
Original Medicare (Part A and Part B)
Original Medicare lets you see any healthcare provider who accepts Medicare without referrals. However, while Original Medicare covers a wide range of services, it does not cover everything. For example, routine vision, dental, and hearing care are not included.
You’ll also need to pay a deductible and coinsurance. To help with these costs, you might want to consider a supplemental plan.
Medicare Advantage (Part C)
Medicare Advantage plans often function as an all-in-one, including Part A, Part B, and sometimes Part D, into one plan. Most Advantage plans have network restrictions, so you’ll need to use doctors and hospitals within the plan’s network, except in emergencies.
Many insurance carriers offer additional benefits with these plans, such as dental, vision, hearing, and wellness programs.
Some plans have lower out-of-pocket costs than Original Medicare, but you’ll still need to pay the Part B premium.
Prescription Plans (Part D)
Every Part D plan will have a different formulary (list of covered medications). Check the plan’s formulary before enrolling to ensure your prescriptions are covered. You also want to make sure your preferred pharmacy is in-network with your plan.
Additionally, review the plan’s premiums, deductibles, and copayments for the drugs you take. The out-of-pocket costs between plans can vary greatly.
Medigap (Medicare Supplements)
Medigap plans help cover the costs that Original Medicare doesn’t, such as copayments, coinsurance, and deductibles. These plans are standardized, meaning the medical benefits are the same across different insurance companies, but premiums can vary.
Tips on how to find the right plan
- Budget: Reassess your finances to make sure you can afford to pay any potential premiums, deductibles, copayments, and other out-of-pocket costs.
- Additional Benefits: Some Advantage plans can offer additional benefits like gym memberships, dental benefits, and more. Decide how important these benefits are to you.
- Travel Plans: If you travel frequently, especially out of state, consider a plan that offers nationwide coverage. Original Medicare generally offers broader coverage than Medicare Advantage.
- Consult with a Medicare Agent: A Medicare advisor can provide personalized advice and guidance based on your specific needs and preferences. They can help you compare plans and understand the differences in coverage and costs.
- Medicare Plan Finder: The Medicare Plan Finder on the official Medicare website is a valuable tool for comparing all available plans in your area.
Mistakes to avoid
Missing Your Enrollment Window:
Missing your enrollment window, whichever one it is, can lead to late enrollment penalties and gaps in coverage.
Not considering other factors:
While lower premiums are attractive, they may come with higher out-of-pocket costs. Look at the plan’s overall cost, including deductibles, copayments, and coinsurance.
Ignoring Network Restrictions:
If you choose a Medicare Advantage plan, make sure your doctors and hospitals are in the plan’s network before enrolling. Going out-of-network can result in higher costs or having to pay completely out-of-pocket.
Not Doing an Annual Plan Review:
Your health and plan offerings can change each year. Review your plans annually and ensure they still fit your healthcare needs and budget.
Conclusion
As you can see, choosing the right Medicare plan requires careful consideration of various factors. Once you understand the types of Medicare parts and plans and what they offer, you can make an informed choice that provides the coverage you need.
