Choosing a new Medicare plan can be an exhausting investigation. I’m sure you’ve read many, many pages in your investigation. So my goal here is not to tell you everything you need to know, but rather a quick read on Key Points to investigate “Medicare Advantage Plans.” The biggest point is do not simply look at dollar cost. Look at Your medical needs. Medicare Advantage plans do have big differences in the details.
Note, we will not cover “extra benefits.” You can decide on your own if a benefit is worthwhile to you.
Key Points
1. Are you healthy and have not seen a doctor or take any medications? You may take the risk of simply choosing a plan that covers the hospital near you.
2. Review your past year’s experience with your current plan.
a. Are you satisfied with your doctors, your pharmacy? Of course if you are not satisfied you will look at other plans. But even if you are satisfied, review your plan for the next year and look for changes that would affect you. They can and do change!
b. If you want to change doctors then determine if the doctor you want is in the plan’s network. Is the doctor accepting new patients?
3. Review Your plans for next year. Are you planning travel? Out of country?
a. If you are traveling in the United States, an HMO may not be suitable since care outside of the HMO providers is typically not be covered.
b. Unless you have an emergency your HMO or PPO plan may not cover medical procedures if where you will be is “out of network.”
c. PPOs can be more expensive than HMO and require more prior authorizations, but can have a much wider provider network and that would be critical if you plan major travel.
d. Out of country travel usually requires additional medical insurance.
4. Are you contemplating any major medical procedures next year? Investigate. Not all plans have the same provisions.
a. Again, is your preferred doctor in the plan network and accepting new patients?
b. Will the procedure requires prior authorization? Are there treatments or procedures you would like to have that will require prior approval?
5. Medications.
a. Check your plan for next year to see if there are changes that affect your prescriptions.
b. If you want to change your pharmacy plan, go into detail about the exact medication, dosage and amount covered by the plan.
And finally note that traditional Medicare does not have the above limitations. But, and a big “But,” you will need a Medigap plan and that will cost you a premium every month. However, if the above Medicare Advantage plan limitations apply then do investigate traditional Medicare plus Medigap plan and you will know you have complete “no surprises” coverage. And finally you will need plus a pharmacy plan that can bring those surprises back into Your plans!
Good Luck and “Happy Trails to You”
Jim