How to Choose a Medicare Plan
- Research your options on Medicare's comparison site and on the Medicare Rights Center Web site.
- Consider a Medigap policy to help with out-of-pocket expenses.
- Medicare Advantage plans sometimes have extra benefits, like eye exams, dental care and hearing aids. But you should make sure you understand the full coverage package, including whether it includes all Medicare benefits.
Privately-run Medicare plans have become more popular in recent years. More than 10 million seniors have enrolled in the so-called Medicare Advantage plans, which are offered by insurers, up from 5.4 million in 2005. But they aren’t the right choice for everyone.
These plans wrap physician and hospital services into one, often with extra benefits, such as vision and dental coverage. Instead of paying doctors and hospitals directly, as it does under traditional Medicare, the federal government pays plans to manage care under the Advantage program. They can have some downsides, so you need to do careful research before you make a choice.
If you’re shopping for a Medicare plan, here are some tips to consider.
Start by figuring out your options. The federal government’s comparison site helps you find plans offered in your area. The Medicare Rights Center also has extensive background and resources available .
If there are no Medicare Advantage plans available in your region, you’ll be in traditional Medicare, the program administered by the federal government. With traditional Medicare, you can use any doctor who accepts Medicare. You’ll pay a set deductible, then a share of the cost of care after that. You may want to consider a Medigap policy to help with those expenses. Such policies can also help with things traditional Medicare doesn’t cover, like emergency care overseas.
If you are considering a Medicare Advantage plan, learn what the plan offers. The Medicare site offers quality ratings as well as general information, but you may also want to get advice from expert sources in your area. One option is your state’s health insurance assistance program, or SHIP. You can find
a directory of these here. You can also go to a local agency on aging, which you can find through the government’s eldercare.gov site.
There are several types of Advantage plans. Most plans, such as health maintenance organizations and preferred provider organizations, manage care to control costs. Like other HMOs and PPOs, they rely on networks of doctors, so you want to make sure that your physicians and the hospital you prefer participate in that network. You may also want to ask about policies on referrals – can you see specialists without a referral from a primary-care doctor? In the case of a PPO, you might want to learn how much you will pay to see doctors who aren’t in the network. The private fee-for-service plans give you more choice because they aren’t required to have a network of doctors and hospitals. But that network exception will end starting in 2011.
Medicare Advantage plans sometimes have extra benefits, like eye exams, dental care and hearing aids. But you should make sure you understand the full coverage package, including whether it includes all Medicare benefits.
Know what the plan will cost. Advantage plans often offer lower premiums than traditional Medicare and supplemental insurance, and they can be good choices if a beneficiary is healthy. But you should weigh your decision carefully, because a private plan may be a worse deal than traditional Medicare if you need hospitalizations and other care for chronic illnesses. Besides the premium charges, you should understand the deductible, or the amount you will have to spend before the plan starts paying, and what you will owe for doctor visits, hospital stays and other care. Another thing to check is the out-of-pocket maximum, or the most you will pay for care in a year.
Check how the plan will work with your current benefits. If you have retiree benefits, you should ask your former employer if you would have to give them up if you leave traditional Medicare.
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how to choose a medicare planSource: guides.wsj.com