Choosing a Medicare Plan
If you are eligible to enroll in Medicare, there are some things to consider before choosing a plan. These key factors include focusing on coverage, costs, and providers.
Coverage Features
Before you choose a Medicare plan, make sure to highlight your coverage needs and go for a plan that meets these needs. This is an important factor to consider when choosing a Medicare plan because enrolling in a Medicare plan that does not have the coverage options you need can result in a loss of money AND proper coverage.
Medicare Part A and Part B cover certain inpatient and outpatient healthcare expenses such as durable medical equipment, skilled nursing facility care, hospice care, etc. If you need coverage for only inpatient and outpatient healthcare services, you can stick with Original Medicare. Now, if you have high out-of-pocket costs from your Part A and Part B coverage, you should consider a Medigap plan. These high out-of-pocket costs can include deductibles, coinsurance, copayments, and more.
If you need prescription drug coverage, you might consider enrolling in Medicare Part D as Original Medicare does not offer coverage for prescription drugs.
Now, let’s say you prefer having the coverage that Original Medicare provides, but you’d like a plan that covers other things like dental, vision, or hearing care. In that case, you can get a Medicare Advantage (Part C) plan. These plans can also include prescription drug coverage.
Costs
Another important factor to consider when choosing a Medicare plan is cost. After checking the coverage features of different Medicare plans, it is important to confirm if you can afford the plan you want. Now, when people first enroll in Medicare, it’s always with Original Medicare first because you typically need to be enrolled in it before you can enroll in other plans like Medigap or Medicare Advantage.
However, Part A of Original Medicare is usually premium-free, while Part B has a monthly premium of $164.90 (in 2023). Both plans also have deductibles. Now, typically when it comes to Original Medicare, Medicare will cover about 80% of medical costs and services and leave the remaining 20% to you. If you find yourself having trouble keeping up with this 20%, you can opt for a Medigap plan.
If you’re more interested in a Medicare Advantage plan, do keep in mind that the costs for Medicare Advantage plans will vary depending on your location, the type of plan you want, and the insurer. You also can’t have a Medigap plan with Medicare Advantage, so the out-of-pocket costs, such as coinsurance and deductibles, will have to be covered by you.
On that note, many Medicare Advantage plans don’t have a monthly premium, but you are still required to pay your Original Medicare premiums. Now, suppose you get premium-free Part A and don’t have to pay a Medicare Advantage premium. In that case, the only premium you will be left to pay is for Part B, which makes this a very cost-effective option for some.
Provider Networks
Medicare plans have different coverage policies, meaning under certain Medicare plans, enrollees are allowed to visit any provider that accepts Medicare, while other plans restrict Medicare coverage to in-network providers.
For example, anyone enrolled in Original Medicare and a Medigap plan can go to any Medicare-approved facility to receive care. However, some Medicare Advantage plans, like HMOs, will require you to stay within their provider network if you want to receive coverage.
For more Medicare help with choosing a plan that works for you, contact us today at 512-432-5414.
Reach out to
Simple Retirement Benefits, LLC
If you are still unsure of which Medicare plan is right for you, we can help. We will discuss all the coverage options with you to determine which plan is best for your needs.
Give us a call today to speak with one of our agents.
