Medicare, Medigap, Medicare Advantage – How do I decide which programs are right for me? The complex rules and all the exceptions to the rules can leave you scratching your head in confusion. The good news is the Medicare program is much improved from what it was several decades ago, and good plans are available for nearly everyone. You can learn more about your plan options by visiting https://boomerbenefits.com/4-things-to-know-about-medicare-supplement-plans/.
In making the decision that works best for you, you need to consider a few things:
- How loyal you are to your primary care physician
- How much you can afford to pay
- How much time you have to manage your medical needs
- Whether it is important to have choices about your plan in the future
- Whether you need vision care, hearing care, or dental care
- Whether you want extra benefits like acupuncture or a gym membership
Are You a Candidate for Original Medicare?
Original Medicare consists of Medicare Part A and Part B. Part A covers hospitalization costs, and Part B covers physician services. Consumers who enrolled in Original Medicare have the option of paying for Part D, which is prescription coverage.
If you’ve worked for over 10 years, you paid into the Medicare program during those years. The time you spent working allows you to receive Part A at no cost. You will have to pay a premium for Part B and Part D if you choose them.
Now that you understand the parts of Medicare you have to pay for, the following eight questions will give you some guidance as to the Medicare plans that are right for you:
Is it a dealbreaker if you have to give up your primary care physician?
If you answered that question yes, Original Medicare may be your best choice. On this plan, you can go to any doctor or hospital you choose that accepts Medicare.
Do you have lots of good physicians in your area and are you not particularly choosey about which one you go to?
Unlike Original Medicare, a Medicare Advantage plan works much like an HMO or PPO. You may only visit hospitals and physicians that are in the network for the full benefit. You may be able to use an out-of-network provider as long as they accept Medicare, but you will likely have to pay more out of your pocket.
Are you willing to pay slightly higher premiums, so you have to pay less each time you receive medical care?
If you answered yes, Original Medicare along with a Medigap plan may be your best choice. A Medigap plan covers the cost of your deductibles, copays, and coinsurance. With ten Medigap plans to choose from, you have plenty of options to fit within your budget.
Do you mind having several ID cards and customer service numbers for medical services and prescription drugs?
Medigap plans do not cover prescription drug coverage, so you will have to purchase the coverage separately if you want to go with Original Medicare and/or a Medigap plan. If don’t mind having one card for Medicare and one for prescription drugs, Original Medicare plus a Medigap plan and Part D might be a good choice for you.
Do you insist upon having only one ID card and one customer service number?
If so, a Medicare Advantage plan is your best choice. Medicare Advantage plans combine Part A, Part B, and Part D into a single, easy-to-manage health plan.
Is the ability to choose a new plan each year during the enrollment plan important to you?
If so, a Medicare Advantage plan is best for you. You can choose a different plan and provider every year and you won’t have to give your health history if you decide to change.
Do you want a few extra perks like a gym membership or global emergency care?
Some of the Medigap plans offer extra benefits. If you go to the gym weekly, you may be able to find an insurance provider that offers a free gym membership. Are you a world traveler? You may want to select an insurance provider that offers worldwide emergency care. If this sounds like you, you are a candidate for Original Medicare and one of the ten Medigap plans. Some Medicare Advantage plans also offer similar perks.
Do you wear glasses? Do you have a genetic predisposition to hearing problems? Do you need to have dental work performed?
If you answered yes to any of these questions, a Medicare Advantage plan will serve you best, as you can get your plan of choice with all these services.
Three Final Choices
Overall, you have three choices – Original Medicare only, Original Medicare along with a Medigap plan and Part D, or a Medicare Advantage plan. No matter what your lifestyle or medical needs are, you can make the perfect choice with Medicare.