Key Things to Consider When Choosing a Medicare Plan

Many seniors are surprised to learn that these Medicare Advantage plans have some impressive benefits including dental coverage.

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Medicare offers health benefits to people aged 65 and above and those with disabilities and some chronic conditions. However, understanding Medicare’s new options and benefits can be confusing.

For this reason, it’s crucial to conduct thorough research about Medicare before open enrollment arrives, bringing new changes. Open enrollment is the one time per year where it’s easy to switch Medicare supplement plans, so make sure to find one that fits your needs.

With that being said, there are some 5 factors you need to consider before changing your current Medicare plan or selecting a new plan. By keeping these factors in mind, you’ll succeed in selecting the right Medicare plan for your health that is within your budget.

1) Type of Coverage Needed  

The Medicare coverage you select plays an important role in everything concerning your healthcare, including the doctors who will attend to you, the out-of-the-pocket costs, premium costs, etc. That’s why it’s crucial to select a plan that will meet your needs fully.  

Under Medicare you’ll find two types of coverage:

  • Original Medicare, or Medicare Parts A and B
  • Medicare Advantage: A Medicare Advantage plan covers all the services offered by Original Medicare, but it also includes additional coverage.

Before selecting any plan, ensure you’ve carefully examined all the details the plan covers. Medicare can work alongside your other insurance coverage, like a health insurance policy provided by your employer.

2) Supplemental Coverage

You can boost your coverage under Medicare by adding Medicare supplemental insurance (Medigap), which you can purchase from private insurance companies.

Medigap often fills in the gaps left by Original Medicare.  It pays for your out-of-the-pocket costs, like coinsurance, copayments, and deductibles.

To receive a Medigap plan, you must be a member of Original Medicare. Don’t forget that you must pay a monthly premium for a Medical supplement plan. You might also have some additional healthcare costs that you’ll have to pay out of your pocket.

3) Prescriptions  

Prescription drugs are one area of healthcare that’s not wholly covered under your Medicare coverage. As a result, you might end up paying significant out-of-pocket costs for prescription drugs.

When selecting coverage,  assess how much coverage you require for prescription medications. If Medicare coverage won’t be able to cover the costs, you can join Part D (Medicare Prescription Drug Plan).  This plan will cover many of your medications, therefore lowering your out-of-pocket costs.

You also have the option of enrolling for a Medicare Advantage plan, since most of these plans cover prescription drugs. If you have a Medicare Advantage plan, but doesn’t cover prescription drugs, don’t worry! You’re eligible for a Part D coverage plan.

It goes without saying, carefully look at the details of your prescription drug coverage before adjusting anything.  You never know you might uncover coverage rules that apply to your prescriptions.

It’s wise to review your prescriptions frequently to make sure they’re covered under your current Medicare plan or Part D or Medicare Advantage plan.

4) Doctor and Hospital Choice

Usually, different doctors accept different health insurance policies or plans. So don’t assume your doctor will accept your Medicare.

The best way to go about this is to consult your doctor and see if he or she will accept the Medicare coverage you’re planning to take, whether it’s Original Medicare, Medicare Advantage, or Medigap Insurance.

Another thing, go over the details of your Medicare plan and coverage to see if there are any restrictions or limitations. 

For Instance, Original Medicare can allow you to see any physician who accepts Medicare.  A Medicare Advantage plan might also allow you to go to hospitals that are part of the plan’s network.  While you might see physicians outside the network, you might incur huge costs.

Before getting a new coverage or making changes to your current coverage, ensure you have details about your doctor and hospital coverage.  This is the only way to know if you’ll stick with your current doctor or you’ll have to find a new one.

5) Dental Coverage

Many seniors know that traditional Medicare does not cover dental procedures. However, they forget that Medicare Advantage plans often do cover routine dental procedures, dentures and dental implants. The best way to find out if a given Medicare Advantage plan covers dental procedures is to contact your provider and ask them. If they do you can save a lot of money on cleanings, exams, fillings and other more extensive dental procedures. Here is a more extensive list of procedures you can expect to have covered if you have a Medicare Advantage plan.

6) Cost

The last factor is cost. You need to figure out how much Medicare coverage will cost you. Although it’s important to ensure that all your healthcare needs are covered, the amount you pay out-of-pocket per year is also very important, especially if you depend on a fixed income.

When it comes to health care insurance most people only think about premium costs, but there’s more to Medicare than premium costs. As a matter of fact, you might pay nothing at all for the premiums, even in Medicare Advantage plans. However, you’ll be responsible for other costs, including:

  • Prescription drug copayments
  • Copayments for doctor’s visits and hospital stays
  • Any yearly limit on out-of-pocket costs
  • The monthly premium
  • The annual deductible

All these are potential costs of Original Medicare, Medicare Advantage Plan, Part D and Medigap.

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If you’re an Original Medicare member, there’s no limit on how much you can pay out-of-pocket yearly. Medicare Advantage plans have a  limit. Once you’ve reached a certain limit, you won’t have to pay for covered services for the rest of the year.  So it’s important to check your plan since every Medicare Advantage plan differs.