When you’re trying to decide about enrolling in Medicare or changing your plan, there’s a lot of information to sift through. And what about those TV commercials you see year-round about plans that offer added benefits?
“It makes you stop and ask yourself: Is my coverage good enough?” says Abbe Udochi, a geriatric care manager and board member of the Aging Life Care Association based in New Rochelle, NY.
With so many choices, it can be tricky to figure out which Medicare options best fit your health needs. Here are some expert tips on how to find a plan that works for you.
Learn What Medicare Covers
You usually get access to this state-run health insurance program when you turn 65. But you can sign up 90 days before your birthday. And that’s a good time to start your research, says Tonya Moody, a Medicare and Medicaid expert with AmeriHealth Caritas, a managed care health plan.
“Start looking into the various plans that are available,” she says. Those include original Medicare, Medicare Advantage, prescription drug plans, and supplemental (Medigap) programs.
Even if you’re already enrolled in Medicare, you might benefit from a breakdown of the basics:
Original Medicare (Part A and Part B). Also called traditional Medicare, Part A covers some of the costs of hospital stays, care in skilled nursing facilities, hospice care, and home health care. Part B includes other kinds of medical services, like doctor visits, medical equipment, and routine things like physicals and vaccines.
Medicare Advantage (Part C). These are private insurance plans that combine the benefits of Part A and Part B. They may or may not cost more in premiums each month than what you’d pay for original Medicare.
You usually have access to a smaller network of doctors on these plans. But your out-of-pocket costs for things like deductibles and copayments may be less than with original Medicare. And they may offer added coverage for things like dental, vision, fitness, hearing, or prescription drugs.
“Some of those extra benefits may include eyeglasses, transportation, hearing aids, or denture repairs that you wouldn’t receive with traditional Medicare,” Moody says.
Drug coverage (Part D). This plan helps pay some of the costs of your prescription medications, which original Medicare doesn’t cover.
What Is Medicare Supplemental Coverage?
With original Medicare, you’re responsible for 20% of Part B medical services once you hit your deductible. And there’s no maximum for how much you may have to pay for out-of-pocket for health care each year.
Supplemental insurance, also called Medigap, helps cover much of these extra costs, including copays, coinsurance, and deductibles. You have to sign up for both Part A and Part B to buy one of these polices.
Debbie Clatsoff, a certified health care advocate and Medicare agent with iWill Advisors, says people often buy supplemental plans because they cover more out-of-pocket costs than Medicare Advantage plans and offer access to a bigger network of health providers.
“You can go to any doctor or treatment center or hospital nationwide. And if they accept Medicare, they have to accept your Medicare supplement,” she says. “But you’re paying for that freedom.”
Things to consider when choosing whether a supplemental plan is right for you:
- Without supplemental coverage, could you cover the 20% Part B coinsurance?
- Are you satisfied with your current coverage?
- Do you travel and need to see doctors out of your state or out of the country?
- Do you live in a rural area but want to see a doctor in another town?
- Do you need access to a big network of doctors and specialists and don’t want to have to get a referral?
- Would you rather pay a higher monthly premium and fewer out-of-pocket costs?
Supplemental insurance usually doesn’t cover prescription drugs or vision, hearing, dental, or fitness services. While you can’t have Medigap and Medicare Advantage at the same time, you can use a supplemental plan alongside a Medicare Part D drug plan.
Many people want to know what the “best” plan is when deciding between supplemental coverage or Medicare Advantage plans. “And the God’s honest truth is there is no best plan,” Clatsoff says. “It’s what’s important to you at this time in your life.”
Ask Questions to Find the Best Plan for You
Original Medicare plans work well for some people, especially if you have health coverage from a former employer. And if you have benefits as part of your retirement package, “you should try them out,” Udochi says.
But it’s important to understand the ins and outs of your plan – whether that’s through Medicare or a private insurer – before a health crisis strikes. “Because once you get sick and there’s a hospitalization involved, it’s very difficult to begin trying to understand what your coverage includes,” she says.
To learn more about what Medicare provides and whether you need extra coverage, Udochi says, come up with scenario-based questions to ask your insurer. Here are some examples to get you started:
- Is my current doctor on your plan?
- Can you send me a list of the geriatricians, internists, and specialists in your network?
- If I need to go to the hospital, what services are covered and for how long?
- If I need to leave the state and I have an emergency, what’s covered?
- What kind of rehabilitation services can I get? How many days of rehab are covered?
- How much will I have to pay out-of-pocket if I get a serious illness like cancer?
- Are my prescription drugs covered?
If you take a certain medication or have an illness that may get worse, ask what kind of coverage you’ll get if there’s a change in your treatment.
You’ll also want to find out whether you’re “dual eligible” for Medicare and Medicaid. If you qualify for insurance coverage based on both your age and income, “some of your costs for copays, medication, or deductibles are paid by the state,” Moody says.
Every state offers different benefits. Visit Medicaid.gov for more information about whether you qualify for free or low-cost health care based on your income, household size, and other things.
Where Can You Learn More About Medicare?
There are people you can talk to who’ll help you understand your Medicare benefits. “These resources exist in every state,” Udochi says. “And they won’t cost you a thing.”
To connect with qualified Medicare experts, you can:
- Reach out to a counselor at your State Health Insurance Assistance Program (SHIP).
- Call the 1-800-Medicare support line (800-633-4227).
- Visit the Medicare.gov website to start a virtual chat.
- Find a licensed Medicare enrollment specialist through the National Council on Aging.
If you’re interested in Medicare Advantage plans or supplemental coverage, many private health insurers offer free consultations.
“It’s overwhelming when you’re first dropped into Medicare, and that’s why I offer free education first,” Clatsoff says. “And that includes what’s covered with the basics of Medicare and all the different health care options they can add to that.”
Show Sources
Photo Credit: JGI / Tom Grill / Getty Images
SOURCES:
Abbe Udochi, CEO, Concierge HealthCare Consulting; board member, Aging Life Care Association (ALCA), Rochelle, NY.
Tonya Moody, vice president, AmeriHealth Caritas Pennsylvania Medicare VIP plans, Philadelphia, PA.
Debbie Clatsoff, licensed insurance agent, iWill Advisors, Coral Springs, FL.
Medicare.gov: “Get Started with Medicare,” “Parts of Medicare,” “Compare Original Medicare & Medicare Advantage,” “Consider these 7 things when choosing coverage,” “A 7-Point Checklist for Choosing a Medicare Advantage Plan,” “Get Medigap Basics,” “Learn what Medigap Covers,” “Learn How Medigap Works.”
Kaiser Family Foundation: “An Overview of Medicare.”
National Council on Aging: “Medicaid and Medicare Savings Programs,” “Who Is the Best Person to Talk to About Medicare?” “Get expert help understanding your Medicare Plan.”
State Health Insurance Assistance Program (SHIP): “Local Medicare Help.”
