For senior citizens, Medicare provides a reliable solution for their healthcare needs. As they make the transfer from employer insurance to Medicare, senior citizens are required to decide on the best Medicare plans that suit their needs.
Unfortunately, the process of deciding which Medicare plan suits you can become a daunting task. You have to consider all the available option and what you stand to benefit from them.
In most cases, senior citizens end up making the wrong choice of a plan because they did not have sufficient information or knowledge about Medicare in order to make an informed decision.
If you are looking to enroll for Medicare or change your current Medicare plan, this article is for you. We have compiled an elaborate step by step guide on how to choose the most suitable plan for your health needs.
Understanding What Medicare Is About and How It Works
Before getting into the details of how to choose an adequate plan, let’s get acquainted with Medicare.
Medicare gets divided into four parts. Each part represents a form of medical care an individual might need. The four parts are as follows:
- Part A- This covers inpatient services at hospitals, nursing homes, etc.
- Part B- This covers outpatient medical services where an individual doesn’t require to get bedridden
- Part C- This provides an alternative means to get Part A and Part B services under an Advanced Plus Medicare Option
- Part D- Provides cover for prescription drug coverage and it may get considered as a supplementary plan or Medigap
There are two main types of Medicare namely Original/Traditional Medicare and Advanced plus Medicare
1. Original Medicare
This type of Medicare is often referred to as Fee-For-Service (FFS) or Traditional Medicare. Under this Medicare, the government pays for the medical services you receive. Additionally, you are free to visit any doctor you please provided they accept Original Medicare.
Key points to remember about FFS Medicare include:
- You do not need any permission or authorization from Medicare to go to a hospital whenever you need care.
- Depending on the plan you choose, you are expected to pay a monthly premium for Part B and in some instances for Part A as well.
- Original Medicare operates on coinsurance. Hence, you get placed in a group. The group co-pays for the medical services they collectively get.
- There are limits to the total amount a hospital can charge toward your healthcare.
- Original Medicare doesn’t cover prescription drugs and hence you may need a supplement plan to help cover for drugs.
- Medicare provides Part A and B services but you can add a Medicare supplemental insurance
To minimize your drug expenses you can opt for subsidy government programs. These programs aim at reducing the cost burden of healthcare premiums by providing subsidies to eligible individuals.
2. Medicare Advanced Plus (H3)
This is a type of Medicare provided by private health insurance companies in conjunction with Medicare. It is often referred to as Part C or private health plan. Under this Medicare, all Part A and Part B services are included but they are grouped into four types of plans. Each plan comes with a different set of rules and costs.
The four network plans include:
- Health Maintenance Organisation (HMO)
- Preferred Provider Organisation (PPO)
- Private Fee-For-Service (PFFS)
- Special Needs Plans (SNP)
Note: When choosing a Medicare Plan, you will have to weigh your medical needs against the above types of Medicare.
A Guide on How to Choose the Best Medicare Plan for You
Now that you have an idea of the different parts and types of Medicare available, let discuss how to choose plans. Below is a step by step process of how to go about it.
1. Determine You Healthcare Needs
A common mistake people make is to pick the cheapest Medicare plan available. In most cases, they do not weigh in their medical needs before making the choice. Hence, they choose a plan that is cheap but doesn’t cover their needs.
When determining your healthcare needs it is essential to look at the previous year’s medical history. This enables you to have an idea of the services you might require in the following year.
You should make a list of all the health services need as well as how frequently you require them. For example, write down if you have a condition that requires regular checkup or medical procedures. Additionally, if you have any prescription drugs you take on a regular basis.
For people who do not require a lot of medical services based on their medical history, Medicare advantage is a common choice. This is because they are able to choose plans that allocate minimal premiums.
For people with numerous medical needs, they can choose the Medicare that best fits their needs. For instance, is a person has a condition that requires Part A and Part B services; they can opt for either type of Medicare.
Additionally, depending on their need for prescription drugs, they can opt to add Part D cover to their Original Medicare. Alternatively, they can choose a Medicare Advantage Plan that covers their prescription drugs.
2. Cover Included
The next consideration to make is what each plan covers. For instance, Original Medicare covers Part A and B services. However, some Medicare Advantage Plans also cover Part D.
If you do not require prescription drug cover, it would be pointless, to take up Part D cover. However, for individuals who require Parts A, B, and D, they have to weigh the options of taking up the Advantage Plan or adding Part D to their Original Medicare Plan.
It is essential to note that Medicare Advantage has more benefits compared to Original Medicare. For instance, the former provides cover for specialist treatments while the latter only covers for the basic medical needs.
3. Costs of Your Medicare
There are numerous types of costs involved with each Medicare plan. The costs include:
- Monthly premiums
- Out of pocket costs
As far as costs are involved, there is no limit to the amount of out-of-pocket costs per year in Original Medicare. Hence, if you choose Original Medicare, you need to get supplementary coverage to minimize your out-of-pocket costs.
For Medicare Advantage, there is a yearly limit to the total amount of out of pocket costs an individual can pay. Once this limit gets achieved, all your medical costs get covered by your plan. However, the full coverage is only available for the remaining part of the year and you need to provide proof.
Medicare Original Premiums are relatively set because the government pays for part of your Medicare. However, Medicare Advantage has flexible premiums. This is because the plans allow an individual to decide the percentage of their medical bills they want to pay out of pocket. The balance in costs gets then covered by the plan. The higher the out of pocket costs, the lower the premiums you pay.
Depending on how much your average health care amounts to, you can pick a plan that is favorable to your budgeting.
For instance, if you have high out of medical expenses, it would be advisable to pick a Medicare Advantage plan. This is because you can choose a plan that enables you to pay higher premiums but low out of pocket costs.
Alternatively, you can choose to pay low premiums and high out of pocket costs if you have minimal medical costs.
4. Your Choice of Healthcare Providers
Under Original Medicare, you are free to visit any hospital or medical practitioner you want; provided they accept the cover. Under Medicare Advantage, you get assigned to a network of healthcare providers. This means that if you visit a hospital or medical practitioner not included in your plan’s network, your plan will not be useful.
Hence, if you choose the Medicare Advantage Plan, you should ensure that your network includes practitioners of all the medical services you need. Additionally, make sure the network is easily accessible from your main area of residence.
There are some Medicare Advantage Plans that provide out-of-network services but they demand higher premiums.
It is essential to note that most networks are composed of private health providers. If you do not have a preference of doctors or hospitals, the Medicare Original plan is a great choice.
Conclusion on Choosing the Best Medicare Plan 2019
Choosing the best Medicare Plan for you comes down to for main factors:
- Your medical needs
- Which plan covers all your medical needs
- How much you pay in premiums, deductibles and out of pocket
- Where you want to get your medical services from
As far as putting together a comprehensive health cover plan, there are a lot of other minor factors that you need to consider. As a result, it can be a daunting task to compare and contrast the various Medicare option provided by numerous private institution.
Thus it is advisable to speak to a local social security office and have them walk you through the best Medicare plans available in your area. They can help you navigate the hundreds of healthcare cover providers so as to get the best Medicare plans in 2019 as well as Medicare supplement insurance.