Tips For Choosing A Medicare Plan

Choosing  a Medicare plan when you are first eligible for Medicare or even switching plans during open enrollment, can be a daunting task. Typically, most people can enroll into Medicare for the first time at age 65. (There are exceptions for people on disability under 65 which can get on Medicare earlier.)  Many people come to us with an exasperated feeling and have so much paperwork, mail, literature, etc., that they just want to stick their head in the sand and wish for it to all be over.  This is where we come in, by educating you and simplifying the whole process. e are some of the things 

We walk our clients through a Medicare 101 process and explain all the parts, plans and timeframes of when you can make changes.  Here are some useful tips for when you are entering this phase in your life.

When you’re first eligible for Medicare, you have a total of 7 months to enroll in a Medicare Advantage plan and/or a Part D Prescription plan. This is called your Initial Enrollment Period (IEP), which starts three months before your 65th birthday month or Medicare eligibility month, includes this  month and ends three months after this month. The effective date starts on the 1st of your effective month, with the exception of a birthday on the 1st of the month, you start 1 month earlier.   If you enroll in a plan after your effective month of Medicare, it starts the first of the following month.

If you enroll into a Medicare Supplement, you have 6 months from your effective month of Part B to enroll in a plan.  But how do you know what type of Medicare plan to choose?  Medicare Supplement plan? Medicare Advantage plan? Part D (Rx) plan? When people come to us already on Medicare, we often have people tell us they have a supplement and then when we get into the details, we realize they don’t, they have a Medicare Advantage plan, and in Santa Clara County, our Advantage plans are all HMO plans.  

Choosing a plan without understanding what the plan types are, can get you in a sticky situation if you’re not aware.  It is complex and if you make the wrong choice, you have to live with it for the remainder of that calendar year, in most cases.  Medicare is confusing at first, but once you understand the basics, it’s easier to understand as you use it.  If you want to do some of your own research, here are some things to consider when choosing a plan.

 Do you need a separate drug plan (Part D) or is it included in your plan (Advantage plan)? Are your drugs covered under the plan? Every plan has a formulary, or list of covered drugs, that you can review to be sure your medication is covered.  What pharmacies can you use or who are the preferred pharmacies?  Most plans have a preferred pharmacy (or more) so if you want to stay with your current pharmacy and don’t want to switch to another, be sure the plan you are looking at includes your pharmacy.  Do they have mail order services? Most plans do, but not all.

What are your out of pocket costs?  These are the amounts shown in the Schedule of Benefits such as premiums, deductibles, co-pays, hospital costs, and diagnostic testing like MRI’s and CT scans. What is your maximum out-of-pocket cost?  This amount is the maximum you could pay in one calendar year.  All of your costs that you pay out of your pocket go towards this amount, excluding the plan premium.

Does your doctor(s) or hospital take that plan?  Advantage plans have networks of doctors and other providers that you must use if you are a member of that plan. Be sure to not just check the Provider Directory of that plan, but call your doctor’s office and ask them also.  Do you need referrals to see a specialist?  With an HMO plan, you do.

How well does the plan cover other needs like Vision and Dental coverage? They could also cover things like transportation or a gym membership.  A lot of people come to us asking about the dental portion of a plan and then want to make a decision on their health plan based on the this.  We don’t recommend choosing your health plan because of the dental benefit.  Choose your health plan based on the health coverage.

Another benefit people often ask us, is does the plan have coverage out of the country?  Most do, but not all, or it’s very limited.  What we recommend, is consider the country or countries you are visiting to find out how they cover medical issues if one was to arise.  Do they expect you to pay?  If so, then decide if the plan has enough coverage or not, and if it doesn’t, consider purchasing a medical travel insurance policy which will give you extra coverage.

These are some of the important questions you should know before purchasing a plan.  If this seems overwhelming, you’re not alone. Almost every client who comes to us, feels this same way.  No one needs to know about Medicare until you go on Medicare, unless you’ve dealt with it with a parent being on Medicare. Many people ask, is this covered, or is that covered? A simple answer is, if it’s medically necessary, it most likely is covered.  It’s pretty much the same as your group or individual coverage, when it comes to the actual coverage.  It’s the amount you pay out of your pocket that should be your concern.  Knowing these costs up front and not when you incur them, makes all the difference in how you feel about your coverage. 

If you don’t want to do your own research, give us a call and we’ll help you to find the best plan to fit your needs and budget.  We can be reached at 408-848-2271 or for a free consultation.


*Photo Credit: The Star

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