Choosing Medicare coverage is a big decision. When you enroll for the first time, you have two primary options: you can choose Original Medicare (A and B) and add a supplemental plan, or you can join a Medicare Advantage plan. Before you decide which route to take, there are many things to consider, including the costs, coverage, prescription drugs, and more. Follow along as Secure Insurance Group explains these variables in greater detail.
First, it’s important to understand any coverage rules that may impact your Medicare costs. How much are your premiums and deductibles? How much do you pay for doctor visits or hospital stays? Is there an annual limit on what you may pay out-of-pocket for services?
In Original Medicare, there’s no yearly limit on how much you pay out-of-pocket unless you have supplemental insurance.
In Medicare Advantage, the plans have an annual cap on your out-of-pocket expenses. So once you hit a certain limit, you’ll pay $0 for covered services for the remainder of the year—which may be cost-effective for you.
Second, consider how well the Medicare plan covers the services you need.
In Original Medicare, your medical services and supplies in doctors’ offices, hospitals, and other health care environments will be covered by Medicare.
In Medicare Advantage, the plans will cover everything that Original Medicare does, and some offer additional benefits like dental, vision, or hearing.
3) Other Insurance
If you have other kinds of health or prescription drug coverage, it’s important to understand how that insurance works with Medicare. If you have employer coverage, talk to your benefits admin or provider before making changes.
Also, consider adding supplemental coverage to your current insurance.
In Original Medicare, you can add a Medigap plan to help cover your out-of-pocket costs. However, joining a Medicare Advantage plan may be a better fit for you financially, since your cost-sharing is lower or included. If you’re in an Advantage plan, you can’t use or be sold a Medigap policy.
4) Doctor and Hospital Choice
Next, you’ll want to address these questions: Do your doctors accept it? Are your preferred doctors accepting new patients? Do you need to choose your hospital from a provider network? Do you have to get referrals?
With Original Medicare, you can see any doctor that accepts Medicare.
With Medicare Advantage, you may have to use healthcare providers who “participate” in the program’s network. In this case, find out how close you live to the network’s doctor or pharmacies. Some Advantage plans offer coverage outside of the network.
5) Prescription Drugs
Nearly 70% of Americans take at least one prescription med. Some people already have creditable prescription drug coverage while others will need to join a Medicare drug plan (Part D).
In Original Medicare, you’ll need to enroll in a Medicare drug plan to get coverage.
In Medicare Advantage, most plans will include drug coverage. If yours doesn’t, you might be able to join a standalone Part D plan.
You’ll want to make sure your drugs are covered under the plan’s list or formulary and ask if there are coverage rules that apply to your medications. After you join, the plan will tell you what your premium will be and whether you owe a penalty.
Last but not least, consider your travel schedule when shopping for Medicare insurance plans.
Original Medicare typically doesn’t cover care outside the country. However, you might be able to purchase a supplemental plan that offers travel coverage.
Medicare Advantage plans typically don’t cover care outside of the country, either. If you travel often, a supplement policy is a way to go.
Contact Secure Insurance Group
We hope this guide helps you when it’s time to choose your Medicare coverage. If you need personal assistance, you can always contact Secure Insurance Group! We represent the top Medicare Advantage and Medicare Supplement carriers in your area, which means we have the best choices to meet your needs. Get a quote online or call (417) 883-9300 to get started.