How To Pick A Medicare Plan

How To Pick The Best Medicare Supplement Plan In 4 Steps

Medicare health insurance generally offers good coverage, but it doesnt cover everything.

However, if you have an Original Medicare plan rather than a Medicare Advantage plan, you also have the option to fill many of the coverage gaps by purchasing a private Medicare supplemental insurance plan, also known as a Medigap plan.

Here are the key steps to finding the right supplement plan for you:

How Do I Find Medicare Advantage Plans Near Me

Every region of the country has access to a different array of Medicare Advantage plans. To find locally available plans, start by going to Medicares website, Medicare.gov. Click on the Find Plans button in the middle of the screen to search for Medicare Part D and Medicare Advantage plans. Users can create an account before evaluating plan options or browse as a guest. Each plan lists out details, including covered services, the in-network hospitals and doctors, and costs. A star rating assigned by Medicare is also included to help users make educated and informed decisions. Seniors who are prepared to make a plan choice can begin the enrollment process online.

Anyone who is eligible for or already enrolled in Medicare Parts A and B is eligible for Medicare Advantage. While enrollment must take place in one of the designated windows, either when first eligible or during open enrollment or a special enrollment period, Medicare Advantage is available to all qualified seniors. Note that some seniors, depending on medical conditions, may only be eligible for SNPs.

Choosing the right Medicare Advantage is an important decision that affects finances and health care. By understanding the available plan types and coverage options, seniors can move forward with Medicare Part C with confidence.

What Costs Are Not Covered By Original Medicare

You can use this tool to check whether Medicare covers a specific service or item, such as medical imaging or a particular vaccine. Some of the items and services not covered by original Medicare are:

• Long-term care

• Hearing aids

• Private nursing care

Medicare Parts A and B don’t include prescription drug coverage, and neither does Medigap. For that, you’ll need to purchase Medicare Part D to keep your out-of-pocket drug costs down, or use copay cards for specific items like inhalers. Coupons from GoodRx also can help you spend less on your medications.

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How Do I Shop For A Medigap Policy

There are a few ways to find out what policies are available in your area.

• Enter your ZIP code on the Medicare search tool to see which plans are offered in your state.

• Contact your State Health Insurance Assistance Program to find out which insurance companies sell Medigap policies in your state. Ask for a “Medigap rate comparison shopping guide.” This program can provide free help in choosing a suitable Medigap policy.

Shop around at a few insurance companies and compare their prices for your preferred plan. In its guide to choosing a Medigap policy, CMS suggests you ask each company these questions:

• Are you licensed in my state?

• Do you sell the Medigap plan I’m interested in?

• Do you use medical underwriting for this Medigap plan?

• Is there a waiting period for pre-existing conditions?

• Is this policy priced using community rating, issue-age rating, or attained-age rating?

• What’s the premium based on my age?

• Has the premium for this Medigap policy increased in the last 3 years? If so, how much?

• Are there any discounts or additional benefits?

Once youve chosen a company, youre ready to fill out your application for your Medigap policy.

Remember that, as mentioned above, new Medigap policies don’t cover prescription drugs. For drug coverage, you will probably need to enroll in Medicare Part D.

Is A Medicare Advantage Plan The Right Choice For You

To access more choices for their insurance coverage, beneficiaries in Florida often choose to receive their Medicare benefits through a Medicare Advantage plan. Approximately 42 percent of Florida’s seniors choose this option over Original Medicare, compared with the national average of 33 percent of beneficiaries who choose an Advantage plan.

While Original Medicare is accessible nationwide, the Medicare Advantage plans available to you will depend on where you live. According to CMS, there are currently 474 Medicare Advantage plans available to Florida residents, and every person who receives Medicare in Florida has access to a Medicare Advantage plan. Even more, many Advantage plans have a $0 monthly premium, and every Medicare beneficiary in Florida is guaranteed access to an Advantage plan with a $0 monthly premium.

The potential downside, however, of an Advantage plan is that unlike with Original Medicare, your coverage will likely be restricted to a network of local providers and services. You may be required to obtain referrals or pre-approval for certain services.

To find out which Medicare Advantage plans are available in your area, visit Medicare.gov and enter your zip code. After answering a few questions, you will be able to view the insurance options available where you live.

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What Are The Advantages Of An Hmo Plan

Many people choose an HMO plan because it covers everything Original Medicare covers plus additional benefits. HMO plans generally have lower monthly premiums than Medicare Supplement plans and are available with prescription drug coverage, so you can have medical and drug coverage in one plan. With an HMO plan, you have a primary care physician, or PCP, who keeps track of all your care and refers you to specialists. With an HMO plan, you have a team behind you to make sure you get the right care.

Why Medicare Advantage Plans Can Fall Short

For many older Americans, Medicare Advantage plans can work well. A JAMA study found that Advantage enrollees often receive more preventive care than those in traditional Medicare. Advantage plans are competing not just on cost but on delivering quality care, says Kenton Johnston, PhD, associate professor of health management and policy at Saint Louis University, co- author of the study.

But if you have chronic conditions or severe health needs, you may want to think twice about Medicare Advantage because of the requirements for pre-authorization and staying in-network, says Melinda Caughill, co-founder of 65 Incorporated, a firm that provides Medicare enrollment guidance to financial advisers and individuals.

If you need to see multiple specialists, and you have to get referrals for each appointment or fight to overturn denials, it can be really challenging, Caughill says.

Steven Feld, 65, a retiree in South Pasadena, Fla., struggled to get coverage for an injection to treat his arthritic knee. The treatment, a prefilled injection administered in a doctors office, is deemed a medical device by the FDA, so the plan twice denied the coverage. When I was on my employers group plan, there was no problem getting the injection covered, says Feld, who joined his Medicare Advantage plan in May.

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The Choices Can Be Confusing And The Fine Print Is Important But Its Crucial To Choose Wisely Because It May Be Hard To Change Your Mind

When most Americans turn 65, they have three basic options for health coverage: traditional Medicare Medicare plus supplemental insurance to cover costs that Medicare doesnt or Medicare Advantage, a range of managed-care plans.

Making the decision isnt easy. Theres a lot of fine print when it comes to expenses and coverage. But choosing the wrong plan for your individual circumstances can be a costly mistakeand one that may be hard to undo, depending on where you live. Most states make it difficult to switch plans, so its often crucial to pick wisely.

With that in mind, here are eight things that every person should know when selecting the Medicare plan that makes the most sense for them. Keep these in mind, and youre less likely to make a choice that youll later regret.

1. Supplemental insurance is usually the best option for people who can afford it or who have health issues.

Ken Schumm of Olympia, Wash., who turns 65 later this year, had planned on buying a Medicare Advantage plan. It seemed the sensible and most-affordable option. Still, he wanted to be sure, since he has rheumatoid arthritis and takes expensive drugs to combat it.

How did you decide which Medicare path to take? Join the conversation below.

2. Having Medicare alone is risky.

It is like not getting home insurance, says Mary Jeanne Cullen, a Medicare consultant in New Jersey. There is financial risk.

Medicare Advantage Health Maintenance Organization

A Health Maintenance Point of Service plan is a hybrid between an HMO and a PPO. This kind of plan combines the higher coverage levels for in-network care typical for a standard HMO with the increased flexibility of a PPO. For those with extensive needs who can afford higher premiums and want a combination of coverage and convenience, an HMO-POS plan can be a great compromise. These plans dont have to include prescription coverage, but some do.

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Choosing A Medicare Advantage Plan In Michigan

According to the Kaiser Family Foundation, one-third of Michigan’s seniors will choose to receive their Medicare benefits through a Medicare Advantage plan instead of receiving their benefits through Original Medicare.

A Medicare Advantage plan is an alternative way of receiving your Medicare benefits. Instead of choosing to receive Part A and Part B from the federal government, you may choose an Advantage plan, which is offered by Medicare-approved private insurance companies. Your Advantage plan will then take the place of Parts A and B, and sometimes Medicare Part D as well.

As a beneficiary of a Medicare Advantage plan, you will receive coverage much as you would through an employer’s health plan in an HMO or PPO network. You will be restricted to a local group of providers, and the plan may require referrals or preapproval for specialist or out-of-network providers. Your copays, coinsurance, or deductibles may be lower than Original Medicare.

Medicare Advantage plans must offer at a minimum the same coverage as Original Medicare, but many plans provide additional coverage. Advantage plans may include hearing, vision, dental, fitness, and preventive care coverage that you will not receive from Medicare Part A and B. Many plans offer prescription drug coverage as well, which takes the place of Medicare Part D.

How Do You Choose The Right Medicare Plans For Your Parents

The idea of picking the right Medicare plan for yourself seems simple enough, but what if you had to do it for someone else? Trying to pick Medicare plans for your parents can be a little confusing. Did you know that 77 million people were born between 1946 and 1964? These individuals are known as baby boomers, and its likely that your parents are one of them. If you have a parent that may become eligible for Medicare or is already eligible, they can learn all about Medicare and compare plans online. They can even apply for Medicare plans online, which is much simpler than mailing in a form or going to the Social Security Office. If you want to know more about picking a Medicare plan for your parent, these are some tips to follow.

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The Cares Act Of 2020

On March 27, 2020, President Trump signed a $2 trillion coronavirus emergency stimulus package, called the CARES Act, into law. It expands Medicare’s ability to cover treatment and services for those affected by COVID-19. The CARES Act also:

• Increases flexibility for Medicare to cover telehealth services.
• Increases Medicare payments for COVID-19-related hospital stays and durable medical equipment.

For Medicaid, the CARES Act clarifies that non-expansion states can use the Medicaid program to cover COVID-19-related services for uninsured adults who would have qualified for Medicaid if the state had chosen to expand. Other populations with limited Medicaid coverage are also eligible for coverage under this state option.

Phase : Initial Coverage Period

The initial coverage period starts after you hit your deductible limit. The Medicare beneficiary has to pay a copay or coinsurance for the medication prescribed by the health worker, but the cost varies according to the formulary.

Drugs in the lower tier will cost you less than drugs in a higher tier. You need to remember that each Medicare plan D creates its own formulary structure. It decides which drugs it will cover and which tier it will fall. In most plans, the beneficiary needs to pay 25 percent of the cost.

You will stay in this Phase until the total amount paid by you and your Medicare plan D do not go above a certain amount for medication. The threshold value in the initial coverage phase limit was $4130 in 2021 and will be $4,430 in 2022. The following table is an example of a formulary tier structure.

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A Filled Medicare Doughnut Hole Tastes Sweeter

Medicares prescription drug coverage is known as Part D. If you choose a medigap plan or an Advantage plan that has no drug coverage, you will also need to purchase a standalone Part D plan to cover medications. The average basic premium in 2021 will be $30.50. As with Part B, the premium rises with income.

Whether you get prescription drug coverage through an Advantage or standalone plan, Part D has two phases: initial and catastrophic, each with different thresholds to meet before medications are covered. The rules and requirements are the same whether youre looking at Medicare Advantage or standalone plans, says Juliette Cubanski, deputy director of the Program on Medicare Policy for the Kaiser Family Foundation.

• Paying Cash Can Help Exit Medicare Drug Doughnut Hole

Between these two phases is a gap in the middlethe famous doughnut hole. Falling into the doughnut hole used to be a form of prescription drug purgatory, where beneficiaries footed the entire bill for medications until the catastrophic phase of Part D offered a measure of salvation. That hole, however, has been filled in steadily over the past several years so that, as of 2020, the cost burden for beneficiaries is lighter.

Using 2021 numbers, heres how Part D works. Formularies and initial deductibles, which Medicare caps at $445, vary with each insurers plan. When shopping for plans, make sure their formulary incudes your medications, says Blankenship. Then look at costs.

Choosing A Medicare Advantage Plan

Medicare Advantage Health Plans are similar to private health insurance. Most services, such as office visits, lab work, surgery, and many others, are covered after a small co-pay. Plans might offer an HMO or PPO network and all plans place a yearly limit on total out-of-pocket expenses. Each plan has different benefits and rules. Most provide prescription drug coverage. Some require a referral to see a specialist while others do not. Some may pay a portion of out-of-network care, while others will cover only doctors and facilities that are in the HMO or PPO network. There are also other types of Medicare Advantage plans.

Selecting a plan with a low or no annual premium can be important. But it’s also essential to check on copay and coinsurance costs, especially for expensive hospital stays and procedures, to estimate your possible annual expenses. Since care is often limited to in-network physicians and hospitals, the quality and size of a particular plans network should be an important factor in your choice.

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Your Medicare Part D Checklist

Not all Part D plans are created equal. Each plan varies in terms of cost, the drugs covered, special rules, and so on. Just because a friend or family member’s Part D plan works for their needs doesn’t mean it will work for yours. Instead, do some homework. Here are 5 simple steps to get started.

Learn More About Medicare

Join our email series to receive your free Medicare guide and the latest information about Medicare and Medicare Advantage.

Some of the types of Medicare coverage you can consider include:

The first step in choosing a Medicare plan is to determine which of these types of plans is best for your situation.

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