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Finding the best Medicare plan starts with understanding your needs
There are nearly 10,000 people becoming eligible for Medicare each day. If you are newly eligible for Medicare you are probably searching for the best Medicare plan.
The good news is you probably have several options from which to choose. Some people receive their medical benefits from original Medicare and a Part D plan.
A larger percentage of people choose to enroll in a Medicare Advantage plan which most often includes Part D coverage. Many buy a Medicare supplement and a Part D plan.
What you choose will depend on your circumstances, namely plan availability where you live, your health and your budget.
Once you work within the confines of your situation you can compare plans, narrow your options and ultimately find the best plan.
What follows is a discussion on the different types of plans and why you may find one to be your best Medicare plan option.
Many people find a Medicare supplement to be the best choice
A Medicare supplement is a standardized plan offered by a private insurance company which works in conjunction with Medicare to help pay your share of expenses for covered services.
A supplement requires a separate premium in addition to your Part B premium. Supplements sold after 2006 are not allowed to include drug coverage. You should purchase a Part D plan to cover your prescription costs.
Contrary to popular belief, this type of plan will not provide benefits beyond what is available from original Medicare. Many people are disappointed to learn for instance, that their Medicare supplement does not include dental or vision benefits.
Although some plans may provide a nominal discount for vision or medications, they can’t be considered credible health insurance benefits.
Why this plan may be your best choice
You may find a Medicare supplement to be the best Medicare plan because of the certainty that it brings. It is true supplemental insurance. Benefits include:
- Standardized plans make comparing easy
- No surprises on out of pocket expenses
- Set monthly premium are easy to budget for
- No network restrictions such as with a HMO or PPO
- Plans do not change each year
Medicare supplement premiums can vary by your location, age, gender, plan chosen, the insurance company and sometimes your health. Obviously if a supplement is not affordable, it’s not your best option.
If you feel that a supplement is right for you, purchase during the Open Enrollment Period. You can also buy a supplement on a guaranteed issue basis during certain times when your circumstances change.
Why you may choose a Medicare Advantage plan over other options
A Medicare Advantage plan is an alternative way of receiving your Medicare benefits. Although you are still enrolled in Medicare and continue to pay your Part B premium, you receive your benefits from a privater insurance company which is contracted with the Centers for Medicare and Medicaid Services.
Plans may or may not require an additional premium but unlike most supplemental policies you will typically be responsible
for sharing the cost of services. Cost sharing can be in the form of deductibles, coinsurance or copayments.
This type of arrangement may be similar to what you were accustomed to prior to being Medicare eligible where you were required to pay a small copay to visit a doctor or receive a diagnostic test.
Advantage plans often require that you utilize a provider network. Plans are often referred to as a Medicare HMO or PPO.
Plans also often include Part D benefits. This often ads convenience to enrolling in and using the plan.
Unlike a Medicare supplement you often receive additional benefits that are beyond original Medicare when you are enrolled in a Medicare Advantage plan.
Benefits often include, dental. vision, hearing and gym memberships.
There are also Special Needs Plans available for people who are receiving both Medicare and Medicaid (dual eligible), people with certain chronic health conditions and people who reside in a nursing home.
Why this plan may be your best choice
The biggest reasons you may find a Medicare Advantage plan to be your best choice is the lower (or lack of) monthly premium and the extra benefits. Other benefits include:
- Low copays are easy to manage versus a high monthly premium
- Convenience of having Part D included
- Having the certainty of a provider network
- General lack of underwriting (must not have end-stage renal disease)
- Plans have an annual maximum out-of-pocket cap
- Ability to choose plans annually
Some people do consider the fact that plans can change benefits and premiums annually to be a negative. You are advised to review your plan and compare plans as needed to make the best choice during the Annual Enrollment Period .
Who chooses Medicare only?
Typically the majority of people who find original Medicare their best choice are receiving benefits from another source. This could be from an employer, spouses employer or military retiree or veterans benefits.
There are rules about which types of plans you can have in conjunction with benefits from other sources. Although many people who receive Veterans Benefits find it advantageous to enroll in a Part D plan.
Many people who can choose a plan beyond Medicare do so because of the potential for high out of pocket expenses when enrolled only in Medicare.
Medicare expenses include:
Part A Deductible – $1184
$296 per day inpatient charge – days 61-90
$592 per day inpatient charge – days 91+
Part B Deductible – $147
20% coinsurance for all outpatient covered expenses
There is not a maximum out-of-pocket amount for Medicare. You will pay 20% of all Part B expenses for covered services. This is reason enough why you should consider either a Medicare supplement or enroll in a Medicare Advantage plan.
Which type of plan is best for you?
As you look over the descriptions of the types of plans available and review the benefits of each, you should have an idea which option will be your best Medicare plan choice.
Speak with an insurance agent locally, visit medicare.gov, or compare Medicare plans online to find the right plan.