Today, people who are 65 and older have more choices in Medicare coverage than previous generations. Most Americans have more than 25 plans to choose from, each offering different premiums, copays, and alliances with certain medical providers and pharmacies. With all of these choices, you need to review all of your options and choose what will work best for you.
Here are six things to consider before picking a Medicare plan:
1. Coverage options
First, take a look at what coverage you currently have. Are you happy with it? Or do you think you need to add something before the next enrollment period? Asking yourself these questions can be helpful, especially if you’re just starting the process of enrolling in Medicare.
Some other helpful questions include:
- Do you want to keep the doctors that you currently see for care?
- Do you travel on a regular basis or spend time at a vacation home for a portion of the year?
- How often do you have medical appointments or other services?
- Do you take prescription drugs on a regular basis?
Depending on what plan you choose, some or all of these questions may factor into your decision.
2. Existing insurance plan
Before enrolling in Medicare, review any existing insurance plans that you intend to continue using. Check with your benefits representative or an insurance agent to find out how this plan’s coverage works with Medicare.
3. Primary care providers
If staying with your current primary care provider is important to you, you will need to find out if they participate with the plan(s) you’re considering. Not all physicians and healthcare providers participate with the plans available. If you choose traditional Medicare, you’re more likely to have the option to stay with your current provider. If you’re looking at an HMO Advantage Plan, you must select a primary care physician from their list of approved doctors. A PPO Advantage Plan gives you a little more freedom and doesn’t require that you use the plan’s approved (in-network) physicians. However, you will pay higher out-of-pocket fees if that is the case.
4. Prescription drug coverage
Traditional Medicare Part A and Part B don’t cover prescription drug costs. If you’re interested in this type of insurance, you will need to purchase the Medicare Part D plan or combined coverage through a Medicare Advantage Plan.
5. Frequent travel or second home
If you travel frequently throughout the United States or spend time at a secondary home for significant periods of time, you should consider electing the traditional Medicare plan. Traditional Medicare is accepted at locations throughout the country and doesn’t require that you select a primary care physician or obtain referrals for specialist visits. HMO and PPO Medicare Advantage Plans are limited to regional areas of coverage. They may also require you to coordinate your care through your primary care physician or use doctors that are part of their network of approved providers.
For most people, Medicare Part A (hospital care) will be provided to you at no charge. Part B (doctor/medical care) of the traditional Medicare plan is an elected plan. You will pay a premium each month for Part B. If you get Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, your Part B premium will be deducted automatically from your benefit payment. If you don’t get these benefit payments, you’ll get a bill. If you elect the Medicare Plan D coverage (prescription drugs), you will also pay a monthly premium. The actual cost of this coverage depends on plans available in your area.