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If you’re getting ready to sign up for Medicare for the first time or you want to switch Medicare plans, you may be wondering: how to choose the right Medicare plan for me? With so many different options available it’s no wonder you have questions. For one thing, you will need to decide between Original Medicare and Medicare Advantage and which part D prescription drug plan suits your needs and budget. You may also be wondering if you should buy a Medigap plan (Medicare Supplement Insurance).
As Medicare agents, we are trained to help kupuna with all their Medicare questions and to provide all coverage options based on individual needs and budget. Your Medicare agent can also check to see if you qualify for any programs such as Extra Help that assists with costs for prescription drugs.
In this article we will explain some Medicare basics to help you choose the right Medicare plan.
How to Choose the Right Medicare Plan for Me
The very first thing to understand is what are the different types of Medicare?
Original Medicare
Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). Part A covers hospitalizations and some skilled nursing facility care, home health care, and hospice care. Part B covers outpatient services, preventive services such as colonoscopies, and durable medical equipment (DME) such as wheelchairs. Original Medicare does not cover prescription drugs or other common needs such as vision, dental, and hearing services.
Access to coverage:
If you are enrolled in Original Medicare, you may receive services from any health care provider or hospital across the United States that accepts Medicare Assignment.
Does part A have a deductible?
While most Medicare recipients do not pay a monthly premium for Part A, there is a Part A deductible for hospital stays as well as coinsurance where patients are responsible for a percentage of their bill.
Does Part B have a deductible?
In addition to the monthly premium, Part B has a deductible and coinsurance where patients are responsible for a percentage of their bill.
More than 70 percent of Medicare beneficiaries are enrolled in Original Medicare.
Medicare Advantage
Medicare Advantage plans (Part C) are an alternative to Original Medicare. Advantage plans are sold by private insurers who contract with Medicare and are legally required to include Part A and Part B. Medicare Advantage plans have been growing in popularity because most plans offer additional benefits, such as dental, hearing, and vision coverage and all plans come with an annual out-of-pocket maximum (unlike Original Medicare). Most Part C plans also incorporate Part D prescription drug coverage (see below).
Access to coverage:
If you are enrolled in a Medicare Advantage plan, you will likely want to receive services from a health care provider or hospital that is in your plan’s network. Seeking care outside of your plan’s network could lead to higher out-of-pocket costs.
Do Medicare Advantage plans have deductibles?
Many Medicare Advantage plans have a $0 monthly premium but most do come with deductibles plus coinsurance and copays.
Medicare Part D drug coverage
Medicare Part D is prescription drug coverage sold by private insurers. Any kupuna who choose Original Medicare or a Medicare Advantage plan without Part D are highly advised to sign up for a Part D plan as soon as they are eligible.
Each Part D plan comes with its own drug formulary. Before choosing a plan, make sure any prescription medication you are on is covered by that plan.
Does Part D have a deductible?
Most Part D plans have a deductible that needs to be met before prescription drug coverage kicks in. Beneficiaries also pay co-pays for the drugs they use but many plans have $0 monthly premiums.
Medicare Supplement Insurance
Medicare Supplement Insurance, or Medigap policies, are designed to help kupuna enrolled in Original Medicare pay for their out-of-pocket health care costs. Medigap policies are not available for those enrolled in Medicare Advantage plans.
Most Medicare Supplement Insurance plans cover at least 50% of the Part A deductible and all Medigap plans also cover 100% of members’ Part A coinsurance and hospital costs for an additional 365 days after Medicare benefits are depleted.
Costs vary for supplement plans.
How do I choose between Original Medicare and Medicare Advantage?
To decide which type of Medicare coverage is right for you, you will need to compare the coverage and costs of the Medicare Advantage plans available in your area with the coverage and costs of Original Medicare with or without Supplement Insurance. Don’t forget to factor in the annual out-of-pocket maximum that comes with Medicare Advantage plans. Next, you will want to consider coverage. Are your doctors, specialists, and preferred hospitals contracted to an Advantage network and/or do they accept Medicare assignment?
Choose your Part D coverage
If you choose an Advantage plan that includes Part D coverage then you’re all set. If you’re going with Original Medicare then you will want to choose a plan that meets your needs based on the types of prescription drugs that you use.
What is the best Medicare supplemental insurance plan?
If you decide to stick with Original Medicare, you may wish to enroll in a Medicare Supplement Insurance plan to help cover your out-of-pocket costs. It is best to sign up for a supplement plan within six months from the time your Medicare Part B begins because outside this window insurers can deny coverage based on preexisting conditions. There are 10 standardized federal Medigap plans available in Hawaii – speak to one of our Medicare agents for help choosing the right plan for you.
Our independent insurance agents are dedicated to helping people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed.
We are now the only insurance agency in Hawaii that is contracted with EVERY Medicare Advantage plan. We also represent all the major supplement plans in Hawaii. These contracts allow us to offer unbiased advice; all at no cost to our clients.
At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.
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