It might seem like there are a lot of steps to follow on the journey to enrolling in the right Medicare plan for you. Realistically, there’s some truth to this. Medicare has a lot of moving parts. But once you understand the basics, you’ll be able to navigate the selection and enrollment process in time for the 2023 Annual Enrollment Period or Annual Election Period (AEP) which begins October 15 and ends December 7, 2022.
Understanding the Parts of Medicare
When comparing plans, it’s important to know what’s included in the different parts of Medicare.
Part A: This Part covers hospital insurance, which can include inpatient hospital care, skilled nursing care, hospice care, home health care, and more. Part A is offered with no premium to nearly everyone who paid Medicare taxes throughout their working lives.
Part B: This Part covers medical insurance, which can include doctor visits, lab tests, medical equipment, and preventative services. Part A and Part B together make up Original Medicare. Whether you choose Original Medicare or Medicare Advantage, you will likely have a monthly plan premium for Part B.
Part D: This Part helps you pay for your prescription drugs. Medicare Part D drug plans are offered by insurance companies approved by Medicare. If you have Original Medicare, you will have to add Part D coverage as a separate plan.
There is also Part C, or Medicare Advantage, which is offered by private insurers. Medicare Advantage provides a bundled option that includes Part A, Part B and usually Part D coverage, as well as extra benefits not covered by Original Medicare.
For a comprehensive guide to the different parts of Medicare, call (833) 923-1869 (TTY: 711) or register for our virtual Unlock Your Medicare seminar today!
Why Consider Medicare Advantage?
People typically enroll in Medicare Advantage plans to access additional health care benefits, including dental, vision, hearing, and more. Medicare Advantage can even cover fitness plans, transportation to doctor visits, and over-the-counter medications. Medicare Advantage plans typically offer low or even $0 monthly premiums.
Interested in learning more about whether a Medicare Advantage plan is right for you? Schedule a free Medicare Review with an Advise licensed agent or call us at (833) 923-1869 (TTY: 711).
Comparing Medicare Advantage Plans
When comparing plans, it’s a good idea to ask yourself a few basic questions:
Do I want to receive all my care from a single network of providers?
Your answer to this question will likely help determine the type of plan that best fits your needs. Generally, Medicare Advantage plans offer three network- specific options.
Health Maintenance Organizations (HMO): HMOs require you to choose primary care providers and non-emergency care providers from within the plan’s network in most cases. However, you can typically see any primary care provider within the plan’s network.
Preferred provider organizations (PPO): PPOs allow you to visit any doctor that accepts your plan. However, you may pay less when you visit a provider from within your network.
Medicare Special Needs Plans (SNPs): Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO) with limited membership to people with chronic conditions or those who are fully eligible for both Medicare and Medicaid. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
What Are My Basic Preferences and Must-Haves?
Beyond network preferences, you may have other basic wants and needs or must-haves. For example, do you have a condition that warrants a specific type of specialist care on a regular basis? Are you interested in extra benefits that Original Medicare doesn’t cover, such as fitness programs, some vision, hearing, and dental services? Some MA plans even cover services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness, or even customize your benefits to treat specific conditions.
No matter how you choose a plan, you’ll need to have a few pieces of information handy. Create a list with the names of your medications, dosages, and frequency, along with your preferred doctors, pharmacies, and any other medical professionals you prefer.
Many people find that the best way to approach Medicare Advantage coverage is to first determine their list of preferences and then speak with an agent to identify a plan that provides the right coverage and fits their budget. If you’re ready to explore plans, call Advise today! (833) 923-1869 (TTY: 711).
Understanding Medicare Advantage Costs
Original Medicare, which includes Part A coverage and Part B coverage requires payments in the form of monthly premiums, annual deductibles, copays, and coinsurance.
Medicare Advantage plans, otherwise known as Medicare Part C, are offered through private insurers and typically bundle Parts A and B together along with Part D (prescription drug coverage).
There are differences in how you pay for Original Medicare versus Medicare Advantage. Medicare Advantage plans are offered through private insurers and have their own costs. However, because you must first enroll in Medicare Part A and Part B before you can enroll in Medicare Advantage, you still need to pay the costs associated with those two parts of Medicare. With Medicare Advantage, premiums can be as low as $0 and provide extra benefits that Original Medicare may not cover, such as some routine exams, vision, hearing, and dental services, depending on the plan you choose.
However, depending on the coverage included within your Medicare Advantage plan, you may have to pay higher out-of-pocket fees or meet a deductible before your plan begins to cover the rest of your medical or prescription drug coverage.
Finally, with Medicare Advantage, you may pay coinsurance, which is a percentage of costs of a covered health care service after meeting your deductible. Or you may pay copayments, a preset out-of-pocket amount you are obligated to pay for each medical service you receive, such as for a doctor’s visit or prescription medication.
In short, both of these plans are structured differently, and so are their costs. With Original Medicare, you may be subject to 20 percent coinsurance after meeting your deductible, copays, no limits to out-of-pocket expenses, and no added benefits (vision, hearing, dental services). Depending on what you are looking for, you may want to enroll in either a Medicare Advantage or Medigap plan to put a cap on out-of-pocket expenses, to include the added benefits, including drug coverage, which some may prefer. If you are enrolled in Original Medicare with a Medigap plan, you will still need to add Part D coverage separately.
Exploring Medicare Advantage and Part D Plans
When searching for plans on your own, make sure to review ratings based on health plan responsiveness and care, member complaints, managing chronic conditions, and more.
Medicare uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Medicare scores how well plans perform in five different categories:
- Staying healthy: screenings, tests, and vaccines
- Managing chronic (long-term) conditions
- Plan responsiveness and care
- Member complaints, problems getting services, and choosing to leave the plan
- Health plan customer service
Medicare assigns plans one overall star rating to summarize the plan’s performance as a whole. You can use the overall star rating to compare performance among several different plans. Star ratings can be found using Medicare’s Plan Finder tool.
Whatever you decide, it’s important to approach the AEP by first identifying your current needs, then assessing your lifestyle, budget, and current plan (if you’re already enrolled in Medicare). No matter your personal needs or priorities, there’s always an option out there that will fit your lifestyle.
Need help finding the right plan for you? Call Advise at (833) 923-1869 (TTY: 711) to schedule your free Medicare Review today.
