Medicare is confusing because there are so many plans and so many choices to make, but the time when you have to choose is getting close. This year’s Medicare Open Enrollment period runs from October 15 through December 7, so millions of seniors will be taking a hard look at their plans and choosing to either stick with their current insurers or make a switch. If you’re less than satisfied with your current plan or just turning 65 and getting ready to pick an insurer for the first time, here are a few things to consider before making a final decision on your coverage for 2015.
Medigap or Medicare Advantage?
Original Medicare insurance consists of Part A covering hospitalization, Part B providing coverage for preventative care like doctor visits and Part D, which covers prescription drugs. All of these cover only a portion of your medical expenses, so most seniors choose to make up the gap in coverage with a supplemental plan.
Medicare Advantage plans are less expensive than Medigap plans and many include extra benefits like vision, dental and gym membership. The cost for this type of plan is often covered by the standard monthly premium for Medicare, currently $104.90, a figure that is expected to hold through 2015. The upside of choosing a Medicare Advantage Plan is that you will pay less than if you choose a Medigap policy and you will be able to do all your dealing with just one company. The down side is that you must stay within your plan’s network of doctors and hospitals in order to have your costs covered. Be sure to check your co-pays and out-of-pocket costs with these policies to avoid nasty surprises later on.
Medigap plans supplement your original Medicare and charge an extra monthly fee in addition to the standard premium. These plans are sorted into categories from A to N with prices going up in relation to the coverage offered. For the maximum protection against paying large out-of-pocket costs as well as the flexibility to make your own decisions about doctors, your best choice is probably original Medicare plus a Medigap plan.
Questions to ask
The first thing you need to know about choosing a plan is that there is no perfect one-size-fits-all policy that suits everyone. You have to take into consideration where you live, how much you can afford to spend and other factors before settling on a plan. Here are a few questions to ask when weighing your options.
Do you want to keep your current doctor or treatment center? If you don’t have a primary physician and have no major medical issues, you may be happy with a Medicare Advantage Plan that offers a range of doctors in your area. However, if you already have serious conditions that require the care of specialists and treatment centers, you should make sure that they are covered by the policy you choose.
Do you want to use the closest hospital and its network of doctors? If so, you’ll need to check which medical facilities are part of the network included in your plan. If you travel frequently, make sure that your policy will cover you wherever you may go.
How to shop
You should be getting a big book called “Medicare and You” in the mail, or you can view the 2015 edition at www.medicare.gov. This site allows you to compare the rates, coverage and other details on all of the plans available in your area at the Plan Finder. If a plan sounds promising, click on the link that takes you to the site of the insurance provider, because this is where you’ll find the important information on doctors, hospitals, co-pays and other details. You can also see what rating the plans have received from those who have used them. You’ll probably be alarmed to discover that some plans sound promising on the surface but have no doctors in your neighborhood or require you to use a hospital on the other side of town.
Doing your research can allow you to winnow the available plans down to a select few. When you have chosen several that sound suitable, call the numbers listed in the Medicare manual or on the web site and ask to talk to a representative. Since these people really want to sell you a policy, they’ll be happy to send an agent to your home and explain what their plans can do for you. In order to get the best policy and avoid wasting time, make a list of your top concerns and tell the agent so he or she can choose which of their policies will serve you best.
Yes, the varied assortment of Medicare plans can be overwhelming, but with a little work, you can cut through the confusion and zero in on what will work for you. For a start, read “Medicare and You” very carefully and mark the pages that pertain to the issues most important to your situation. This will give you a basis for the list of questions you present to the insurance agents. For more information, order the book “Medicare for Dummies” from Amazon. By the time you wade through all 384 pages, you’ll know just about everything there is to know about Medicare!
Sources: www.medicare.gov, 1-800-MEDICARE
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