Choosing a Plan with Medicare

December 28, 2016

It can become a little overwhelming to choose from so many options, and Medicare has many to offer for customized health benefits.  Here are a few things to consider while choosing your health plan:

  • Your needs: The first thing that you need to do is make a list of your needs.  Unless you know your needs, it will be hard to determine the suitability of a plan.
  • Plan coverage: Once you have your needs listed, you can identify which of the plans best covers the services you need.  Medicare details each plan’s coverage on its website:
  • Other coverage: You can be enrolled in more than one coverage options.  This ‘other coverage’ could be offered by your employer, or the Indian health or Tribal Health Program.  In such cases, make sure you understand how this coverage will work with Medicare.  Contacting your benefit administrators or insurer would help clarify things.
  • Costs: Be aware of how much you are, or will be, paying for your premiums, deductibles, and other costs like hospital stays and doctors visits.  Also find out out-of-pocket maximums.  Make sure you understand any coverage rules that may affect your plan costs.
  • Doctor and hospital choice: Make sure you know if your doctors accept your coverage, and if they are accepting new appointments.  Also look for information on networks of health care providers and pharmacies that you might be required to use in certain plans.  Some plans also require doctors’ referrals for certain kinds of coverage.  Make sure you know about such conditions before enrolling.
  • Prescription drugs: If you require prescription drugs, find out if they are covered by your plan.  If not, see if enrolling with Prescription Drug Coverage (Part D) will help.  Note that even Part D might not cover some prescription drugs.  Talk to your doctor in such cases.  In addition, find out what your prescription drug will cost you under various plans.  Consequently, find out if you are eligible for free Medication Therapy management (MTM) program.
  • Care: The quality of care is also an important consideration if you are looking to shop for plans.  Please check rating for plan care and services before enrolling.
  • Convenience: Consider distance from doctor’s office, their hours, and pharmacies that you can use.  Make sure both are in your plan’s network.  Also find out if your doctors use electronic health records (EHRs) or E-prescribe?  See if you can receive electronic copies of bills, personal information, and medical records.
  • Travel: If you travel frequently, you need to make sure that your plan covers you while traveling to another state or outside the US.  You can review your ‘Evidence of Coverage’ and ‘Annual Notice of Change’ that are mailed to you every year to review coverage benefits, or changes in plans.  You can also speak to your plan for details.

To seek advice on coverage options, and detailed information on Medicare plans, you can contact Medicare at 1-800-MEDICARE, or speak with a Medigap licensed insurance agent at 1-855-214-4404.

This is not a complete description of Medicare coverageFor more information, speak with Medicare customer support at 1-800-MEDICARE, or contact Medigap, Inc. at 1-855-214-4404.

Source: Medicare

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