Choosing a Medicare Plan

When choosing a Medicare plan, look at the costs, the coverage and your health care needs for the best fit.

Factors That Go Into Medicare Plans

The costs and benefits of each plan are most important, followed by the convenience, your provider choices and your care needs.

Cost: Medicare plans, like all health insurance, come with copayments, premiums, coinsurance, and deductibles. Original Medicare does not have a maximum out-of-pocket limit, which creates the potential risk of sky-high out-of-pocket costs. Medicare Advantage plans have out-of-pocket maximums to protect you from that concern. Medicare Supplements were built specifically to help pay for the out-of-pocket costs from Medicare Part A and Part B. 

Generally, you pay 20% of the Medicare-approved amount as coinsurance once you have met the deductible. For inpatient care in a hospital, mental health facility, or skilled nursing facility, you will also be charged a daily coinsurance after a certain amount of days go by.

You still need to pay your Part A and Part B premiums if you have a Medicare Advantage or Medicare Supplement plan. Costs will vary between plans. The more extensive your coverage, the higher your premiums are likely to be. Supplemental packages will come with additional premiums.

Benefits: Medicare is notorious for its gaps in coverage. Original Medicare has no routine care for dental, vision, or hearing health nor does it cover routine podiatry, chiropractic care, acupuncture, or cosmetic surgery. Medicare Advantage plans may offer some of these benefits for an additional premium.

Providers: With Original Medicare, you can see any health care provider that accepts Medicare. If you have a Medicare Advantage plan, you may need to switch primary care doctors to one who is in the plan’s network. You will pay more for seeing providers outside of the plan’s network.

Convenience: Depending on the type of Medicare Advantage plan you choose, you may need to switch health care providers or get a referral from your doctor to see a specialist. Some plans, like Private Fee-for-Service plans, have specialized payment plans that allow you to see any provider who agrees to treat you and accepts your plan’s payment terms. Does the plan have good customer service? Consider the accessibility of your care when deciding on a plan.

Your Health Care Needs: A large component of deciding how much coverage you need depends on how much health care you are currently receiving or expect to receive. Do you take prescription medications? You may not now, but will likely need some in the future. Signing up for a prescription drug program when you are first eligible will help you avoid the late enrollment penalties that last for the lifetime of the policy. If you have a disability or chronic illness, this will impact your health care needs as well as your potential expenses, so you will want full coverage and help paying your out-of-pocket costs.

Finding the Right Medicare Plan

Your health insurance choice will make an impact in the coverage you receive and the monthly payments you will need to make. Some of these choices can impact the costs of your policy in the long term. Make your selection to cover your prescription drugs, suit your out-of-pocket needs, and care for your health maintenance. The Coleman Agency can help you sort through your Medicare choices to find the best fit.


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