Only three years ago, over 17 percent of the United States population was covered by Medicare. As Baby Boomers and members of Gen X continue to age and retire, an increased number of people will require Medicare coverage and assistance in choosing the right plan. Although Original Medicare provides good health coverage, it may not always be enough for your specific needs. Provided by the government, Original Medicare offers partial coverage for hospital and medical coverage, such as hospitalization, nursing care, doctor’s visits, surgery and more. Some individuals may want to explore the added benefits of Medicare Advantage plans (which must cover the same benefits as Original Medicare) that typically add benefits in areas such as prescription drug coverage, dental, vision and hearing coverage.
Plans Similar to Your Pre-Medicare Insurance
How do Medicare Advantage Plans work? Essentially, they provide you with all the Medicare benefits you need in a single package offered by a private insurance company. This should sound familiar, particularly if you’ve paid for private insurance before. Like private insurance packages, Medicare Advantage plans can vary in terms of added benefits above Original Medicare-mandated coverage. Many plans offer options with no additional premium cost above your cost for Original Medicare, but it’s important to evaluate coverage based on included benefits and not be misled by premium costs.
Generally, Medicare Advantage plans offer all the benefits provided by Original Medicare, and additional benefits (based on your choice of plan) in the form of dental coverage, prescription drug coverage, care for your hearing and vision needs and more.
Picking the Right Medicare Advantage Plan
As you begin to browse through the available list of plans on the market, you will notice how varied they can be. Before letting the differences overwhelm you, make a few notes. Focus on where the differences can be found for different plans – physician and facility networks, drug formularies, copayments and out-of-pocket (OOP) maximums. Note that in 2020, the maximum OOP mandated by the Centers for Medicare & Medicaid Services (CMS) is $6,700 per person.
Get started by first writing down the names of your current physicians or healthcare groups. Most Medicare Advantage plans are Health Maintenance Organization (HMO) plans, meaning they’re network-based in accessing care, while other Medicare Advantage plan types (e.g. PPO, POS and PFFS plans) offer additional options for obtaining out-of-network care. Then, create a list of any prescription medications you take. All medical insurance plans work from a formulary of approved prescription medications and may offer tiers of prescription copayment amounts based on that formulary. These important considerations should guide you as you begin to explore and compare plans online. Though you probably want to pay the lowest premium you can, be aware that higher premiums can make sense and reduce your total out-of-pocket costs. In some cases, what appears to be a Medicare Advantage plan with a higher premium and added benefits may actually save you hundreds or thousands of dollars in the long run when you consider the out-of-pocket expenses under a plan with lower premium payments.
This is one of the more confusing aspects of choosing a Medicare Advantage Plan. Medicare Portal has experienced, local Medicare insurance agents who can also help you navigate the complex field and pick the right coverage options.
Changing Your Medicare Coverage
After choosing coverage benefits and enrolling in a Medicare plan, some people discover their plan was not the right fit. Regardless of your initial choice of plan, there is a specific time frame in the year where you can change your coverage during the enrollment period that applies to you. Even if you already have Original Medicare with or without Medigap (supplemental coverage for health care costs), Part D coverage (prescription drug coverage) or another add-on, you can switch to a Medicare Advantage plan during certain enrollment periods.
During the Annual Enrollment Period (Oct. 15th – Dec. 7th), Medicare recipients are allowed to change existing coverage or enroll in a new plan – whether that be Original Medicare, Medicare Advantage or Part D coverage. Changes go into effect on January 1st of the following year.
If Medicare Advantage enrollees need to change their coverage choice after the AEP has passed, during the Open Enrollment Period (Jan. 1st – Mar. 31st) they have a one-time opportunity to change their Medicare Advantage plan or switch to Original Medicare for the rest of the year.
It’s important to understand your options, choose the right initial Medicare coverage plan, re-evaluate annually if it fits your needs and budget and make necessary adjustments at the proper enrollment periods.
Taking the Confusion Out of Medicare Coverage and Plans
Still feeling a little bewildered when it comes to eligibility for Medicare and the pros and cons of Original Medicare versus Medicare Advantage plans? Medicare Portal can help support you in making the right choice for your continued health and well-being, in both enrolling in your chosen plan and re-evaluating your coverage needs as time goes by. We are here to serve you – our local Medicare insurance agents are available over the phone, online and in-person to offer free Medicare consultations and assistance.