How to Find the Best Medicare Plans: Key Considerations

You want the best for yourself, especially when it comes to healthcare coverage. If you’re eligible for Medicare, you probably have many Medicare Advantage and Medicare Part D plans to choose from. But how do you know which ones are the best Medicare plans for you?

Well, in the case of Medicare, it’s really a question of which plan is best for you. The plan that fits your needs perfectly might not be the plan that meets another person’s needs perfectly.

When selecting a Medicare plan, there’s a lot to consider. Here’s what to look at to find a plan that’s right for you. 

The Right Plan Type

How your Medicare Advantage plan works will depend on what type of plan it is.

Some Medicare Advantage plans are Health Maintenance Organizations (HMOs). If you enroll in an HMO, you may not be covered if you see out-of-network providers. You may also have to get a referral before seeing a specialist.

With a Preferred Provider Organization (PPO), you can typically see out-of-network providers, but your out-of-pocket costs will be higher. You probably won’t need a referral to see a specialist.

Another plan type is the Private Fee-for-Service plan. Some of these plans may not have a network, meaning you can see any Medicare-approved provider, and you probably won’t need a referral to get a specialist.

Each plan type has its pros and cons. For example, although HMOs can seem restrictive to some, you may have a lower premium cost compared to other plan types.

The Right Network

If you’re interested in a Medicare Advantage plan that uses a network of hospitals and providers – and that’s most of them – it’s important to make sure that you’re happy with the network. If you receive care from a hospital or provider who is not in your network, you may have significantly higher out-of-pocket costs.

• See which local hospitals are in the network. If you have a hospital that you prefer, make sure it’s included.
• See which local providers are in the network. If you regularly see a primary care doctor or any specialists, make sure they’re included.

Networks can change over time as providers enter or exit. This means that there’s always a chance your favorite doctor or specialist will stop being in your network. If this happens, the plan that used to be right for you may no longer be right for you, and you may want to consider switching plans at the next opportunity. Alternatively, you could look for a different provider who is in your network.

The Right Prescription Drug Coverage

When selecting a Medicare Part D plan or a Medicare Advantage plan that includes prescription drug coverage, it’s important to make sure your current prescription drugs are covered and that your copay won’t be too high.

Prescription drug plans typically use a formulary, which is a list of the drugs they cover. Some formularies are tiered, and prescriptions in different tiers will be covered at different levels.

Before comparing plans, you should make a list of your prescriptions, including the dosage. You will be able to see how much you’ll pay for your prescriptions with different plans.

The Right Benefits

Medicare Advantage plans often offer benefits that are not covered under Original Medicare. The types of additional benefits vary significantly from plan to plan, so it’s important to make sure your plan has the benefits that fit your needs.

• Many Medicare Advantage plans include prescription drug coverage. If you enroll in one of these plans, you will not have to purchase a separate Medicare Part D plan for prescription coverage.
• Many Medicare Advantage plans include coverage for hearing aids, dental care and/or vision care. These benefits are not typically covered under Original Medicare.
• Some Medicare Advantage plans include expanded telehealth coverage. You may be able to receive certain types of care from your home instead of having to go to a health care facility.
• Some Medicare Advantage plans offer additional benefits, including non-medical benefits. For example, a plan might cover transportation to doctor’s appointments, meal delivery or adult day care services. Recent rule changes have allowed Medicare Advantage insurers to expand their benefit offerings, so you should check to see if there are any new benefits in your area that could help you.

The Right Special Needs

Medicare Special Needs Plans cater to beneficiaries who meet certain criteria. All Special Needs Plans include prescription drug coverage, and many include additional benefits designed to help the specific needs of the populations they serve.

• If you have a chronic condition, see if there is a Chronic Condition Special Needs Plan (C-SNP) in your area that caters to your chronic condition.
• If you are also eligible for Medicaid, see if there is a Dual Eligible Special Needs Plan (D-SNP) in your area.
• If you require institutional care, see if there is an Institutional Special Needs Plan (I-SNP) in your area.

The Right Premium

Although most people qualify for premium-free Medicare Part A, you must pay a premium to purchase Medicare Part B.

If you choose to enroll in a Medicare Advantage plan, you will have to continue paying your Medicare Part B premium as well as any premium charged for the Medicare Advantage plan. However, some Medicare Advantage plans have a $0 premium, meaning you don’t pay any premium beyond the Medicare Part B premium. In 2020, the average expected Medicare Advantage monthly premium is $23, according to CMS. 

If you enroll in Original Medicare, or if you enroll in a Medicare Advantage plan without prescription drug coverage, you can enroll in a Medicare Part D Prescription Drug Plan. You will need to pay a premium for coverage. CMS says that the projected monthly premium for Medicare Part D is $30 in 2020.

The Right Out-of-Pocket Costs

When comparing Medicare plan costs, you should not limit your comparison to premiums.

The premium is what you pay, usually every month, to purchase coverage, but it is not your only cost. Your out-of-pocket costs also include the deductible, which is what you pay before the insurer starts paying, and the copay or coinsurance, which is what you pay every time you receive care or get a prescription filled.

Medicare Advantage plans often have lower out-of-pocket costs compared to Original Medicare. They also have an out-of-pocket limit, unlike Original Medicare, and they may offer additional benefits. However, out-of-pocket costs can vary by plan and service, and you may be required to stay in-network to get full coverage.

Before deciding on a plan, make a list of the benefits you are likely to need throughout the year. Then see how they are covered under the plan and what your expected out-of-pocket costs will be. This will give you a much more accurate idea of your total expected costs than just looking at the premium would.

Getting It Right

Selecting the best Medicare plans for your needs can take some effort, but it’s worth getting right. The plan you pick will determine what care is available to you throughout the year. It will also have a major impact on your finances.

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