Medicare

What type of Medicare plan is best for me?

Choosing a Medicare Plan can be confusing and daunting!

Consider these important factors when choosing coverage:

Premium costs

How much can you afford monthly for your plan premium?  Are you on a fixed budget and need to keep the premiums down?

Out of Pocket Costs

Consider how much your deductible is and what you will pay for services like hospital stays and doctor visits. What is the yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.  While some plans may look attractive with low premiums, you may end up paying more for your medical costs than other plans.

Doctor and Hospital choice

You will want to make sure the doctors you want to see participate in your chosen plan’s network. Medicare supplement plans use Medicare’s nationwide network of providers (found at www.medicare.gov) where Medicare Advantage plans use an insurance company’s specific network of providers, and Medicare Advantage plans offered by the same carrier can have different networks of providers. Another thing to consider is referrals. Many Medicare Advantage plans do require a referral from your primary care doctor before you can see a specialist. 

Prescription Drug Coverage

It’s important do know how much your prescription drugs will cost you under your chosen plan. Does the plan’s formulary (a list of drugs the plan covers) cover all of your prescription drugs? Are there any coverage rules that apply to your prescriptions such as prior authorizations or quantity limits? Plans can vary greatly in prescription drug costs.

Travel

Do you travel out of your local area often? Medicare Advantage plans typically cover only emergency services outside of the local area whereas Medicare supplement plans offer coverage nationwide for both non-emergency and emergency services.  Some Medicare Supplement insurance plans offer extra coverage for foreign travel as well.

Plan Rating

Consider Medicare’s plan rating before purchasing coverage. Medicare Advantage and Part D plans are rated on a scale of 1 to 5, with a 5-star rating being the highest score a plan can receive. More stars indicate better performance and quality. For example, a 5-star rating is “Excellent” and a 4-star rating is “Above Average. Medicare reviews plan performance yearly and releases new star ratings each fall. This means plan ratings may change from year to year.

Medicare Advantage plans are rated on how well they perform in five different categories:

  1. Staying healthy: screenings, tests, and vaccines
  2. Managing chronic (long-term) conditions
  3. Plan responsiveness and care
  4. Member complaints, problems getting services, and choosing to leave the plan
  5. Customer service

Part D plans are rated on how well they perform in four different categories:

  1. Customer service
  2. Member complaints, problems getting services, and choosing to leave the plan
  3. Member experience with the drug plan
  4. Drug pricing and patient safety

Benefits and coverage are just one part of the decision. You will also want to choose a plan with a good reputation, who is easy to work with.