How To Pick A Medicare Plan
Selecting a medicare plan may sound simple, but it is not as simple as you may think. Your Medicare coverage can change from year to year depending on which plan you selected when you were first eligible for Medicare.
If you are like 42% of Americans signed up for a Medicare Advantage plan in 2021. This is out of 46 million Medicare beneficiaries. This means 19,320,000 people need to review their Medicare plan in October of each plan year.
If you are part of the 58% of Americans who signed up for Original Medicare with a Supplement, you get to sit back and relax related to your Medicare coverage. This is because your Medicare supplement plan never changes.
All Medicare beneficiaries need to also review their Part D prescription drug coverage each October, as these plans also change from year to you.
Ensure you review your Part D coverage annually, no matter if you obtain your Part D coverage through your Advantage plan or on a standalone Part D plan.
It is important to review these benefits each year, to ensure you are fully protected.
Should I Purchase A Medicare Plan Online?
Many companies now offer the ability to purchase a Medicare plan online. We do not recommend purchasing the Medicare plan you found online, as there are many things to consider outside of the monthly premium. This includes those Medicare plans that include a zero dollar monthly additional premium.
We encourage you to start with an online Medicare quote, to see what is available to you in your area. However, many of these quote platforms do not include all available companies or plans.
In addition, these online quotes do not factor in all of your medical cost, doctor availability, networks available under the plan, access to medical facilities, cost for prescription drugs, and many other things that are important. Some states may not be included under the online system as well.
This is where working with an experienced Medicare insurance agent comes into play. When you give your Medicare insurance agent a call, they will ask additional questions so they can better understand what is important to you and your healthcare needs.
Once you have been made aware of the differences, your Medicare insurance agent can better guide you in selecting the Medicare plan which best meets your needs.
Things To Consider When Purchasing A Medicare Plan
Depending on your state, county, and zip code, the Medicare plan and coverages available to you can change. It is always important for your Medicare insurance brokers to know your zip code so they can begin to evaluate what is available in your local area.
If you are considering obtaining a Medicare Advantage plan, your Agent will need to know the following information:
- Confirmation you are enrolled into both Part A and Part B of Medicare
- Your date of birth
- Must have doctors
- Must have medical facilities
- List of your prescription medications
- Any medicare conditions that can impact the Medicare plan selected
- Medicare advantage plan are all guaranteed issue
- Part D plan is typically included with your Medicare advantage plan
If you are leaning towards a Medigap plan, your insurance agent will need the following information:
- Confirmation you are enrolled into both Part A and Part B of Medicare
- Your date of birth
- Are you enrolling under a guaranteed issue period
- List of your prescription medications
- If outside guaranteed enrollment period, a medical questionnaire will be required to verify eligibility or not.
- Selecting a standalone Part D plan
When considering which plan to select, it is important to consider not only your current health, but your future health. Will the Medicare plan you select provide you with the needed healthcare benefits both today and tomorrow.
You should never consider obtaining a plan based on their access to a gym membership or any other freebies you will gain if you select their plan. It is critical to select a plan based on the overall health coverage you will receive.
Your monthly income can also be a factor of what plans we can consider. You need to let your Medicare insurance agent know about your financial situation. This way we can narrow our search of available Medicare plans.
Does Medicare Cover Cancer Facilities?
The odds of getting cancer now affects 1 in 2 women and 1 in 3 men individuals. With these odds stacked against us, it is important to have access to quality care related to getting cancer.
Getting diagnosed with cancer can be heartbreaking news. The last thing we want to find out is we are not able to go to the top medical facility related to our specific cancer. No one wants to be stuck with second best.
If the odds of surviving are much higher at the Mayo Clinic, that is where I want my spouse to be able to go.
Currently the top 10 cancer facilities are:
- University of Texas MD Anderson Cancer Center, Houston
- Memorial Sloan Kettering Cancer Center, New York
- Mayo Clinic, Rochester, Minnesota
- Dana-Farber/Brigham and Women’s Cancer Center, Boston
- Cleveland Clinic
- Johns Hopkins Hospital, Baltimore (tie)
- Northwestern Memorial Hospital, Chicago (tie)
- UCLA Medical Center, Los Angeles
- Cedars-Sinai Medical Center, Los Angeles
- Hospitals of the University of Pennsylvania-Penn Presbyterian, Philadelphia
Most Medicare Advantage plans exclude these cancer facilities. In additional some of these facilities refuse to allow patients from a Medicare Advantage plan to be seen at their medical facility.
These top facilities may only be accessible with a Medicare supplement Plan G. Based on the odds of getting cancer, this needs to be part of your Medicare plan decision process.
Medicare Advantage plans will require the insurance company to approve all services and referrals. This includes the cancer drugs, allowed by the Medicare advantage plan.
The Medicare advantage plan may only allow a lower cost drug to first be used, even if your Doctor recommends a different drug.
With a Medicare supplement plan, if your doctor says you need drug A, as long as it is part of your drug formulary that will be the cancer drug used. In most cases the cancer drug is approved by the FDA and is listed on the Part B drug formulary.
The major difference between a Medicare Advantage plan and a Medicare Supplement Plan.
Under a Medicare Advantage plan, the medical network that is part of the Advantage plan, decides what level of care and drugs that are allowed to be used as part of your overall care.
With a Medicare Supplement plan your doctor is the one who decides the level of care you need, in order to be cured of your cancer.
Should I Sign Up For A Medicare Advantage Plan?
Medicare advantage plans have gained in popularity over the past few year. They can be a great option when consider them as part of your available Medicare plan options.
Depending on where you live, will change what is available to you and if the private insurance company will charge a monthly premium for their Medicare plan. Many Medicare Advantage plans can be obtained and are available for no additional premium.
These zero monthly premium Medicare advantage plans, are why so many Americans are signing up for these types of plan.
Before you can sign up for a Medicare Advantage plan, you are required to be enrolled into Part A and Part B of Medicare. Most Medicare Advantage plans include Part D as part of their plan.
You are not allowed to purchase a standalone part D plan if you sign up for an Advantage plan.
When signing up for an Advantage plan, you will want to make sure the plan network selected, covers all of your must have doctors and medical facilities. Please keep in mind, the medical network you sign up for this year may not be available in the future.
You will want to review the copays, max out of pocket cost, and drug formulary included in your Medicare Advantage plan.
While your plan may not include a monthly premium, it may include a max out of pocket cost from $500 to $7,550 for in-network providers and $11,300 for in-network and out-of-network services combined.
These cost begin to become a hardship for many Medicare beneficiaries as they age and become sick.
Some Medicare advantage plans include an additional monthly premium. This monthly premium is in addition to your Part B monthly premium. Make sure you are aware of all your Medicare cost, before signing up for a Medicare plan.
For those individuals who are generally healthy, a Medicare advantage plan can be financially beneficial. They can also include some value added benefits, depending on which Medicare plan you select.
It is vital for you to fully understand all of the pros and cons that may be included with a Medicare Advantage plan. What may work for you, may not work for your spouse or close friend.
Should I Sign Up For A Medigap Plan?
Original Medicare offers some really fantastic coverage, but it also leaves behind some gaps in coverage. When considering a Medicare plan, a Medigap plan should be on the top of your list of Medicare plan options.
Many people refer to a Medicare supplement plan as the best of the best. Other say, why would I pay a monthly premium to fill in the gaps when a Medicare Advantage plan does not have a monthly premium.
A Medigap plan, depending on which one is available to you, can cover 100% of the cost of your medicare approved bills.
Unlike a Medicare Advantage plan, a Medigap plan does not include any co-pays, deductibles, or max out of pocket cost. This assumes you are eligible for the Plan F.
For those who sign up for a Plan G, the only cost you will incur is your annual Part B deductible. Once the Part B deductible has been paid, all future services for the fiscal year will be covered at 100%….
Many Medicare beneficiaries sign up for a Medicare Supplement plan, as they want or need the freedom of going to any doctor and medical facility of their choice. They also want their doctor to be the person in charge of their medical needs, and not the medical group.
Lastly, with a Medigap plan, beneficiaries are not required to obtain a referral to see a specialist nor do they require prior authorization to have a procedure done.
If the doctor is available to complete a knee surgery 30 minutes after seeing you, they can schedule and complete the needed surgery.
For those individuals signed up for a Medigap plan, this means they are able to be in pain for a shorter amount of time, and to get fixed faster. Your quality of care increases, which means your quality of life also increases.
Make Sure You Sign Up For Part D Coverage
When signing up for a Medicare plan, it is important that you sign up for all of the required parts of Medicare. If you forget to sign up for a specific part, this can and will come back and cost you.
When you become eligible for Medicare, it is important to sign up for Part A, Part B, and Part D of Medicare. If you do not have creditable coverage in place from an employers plan, Part B late enrollment penalty and Part D late enrollment penalty.
These late enrollment penalties, continue to increase monthly and yearly. Once you sign up for either of these parts the penalty stops increasing, however, the penalty remains with you for the remainder of your life.
If you sign up for a Medicare Advantage plan (“MAPD”), many of them include a Part D plan as part of the overall coverages. The Medicare plan will include a single Part D plan option, that is made available to you through the MAPD plan.
If you sign up for a MAPD plan and you are not happy with the prescription drug coverage that was included, you are not allowed to obtain a standalone Part D Medicare plan. If you attempt to sign up for a standalone Part D plan, you will be disenrolled from your Medicare advantage plan.
If you select a Medicare Supplement plan, you will need to sign up for a standalone Part D plan. Most beneficiaries will have the option to select from 20 or more standalone plans.
When selecting a standalone Medicare plan, it is important to understand which plan is best for you. Your Medicare insurance agent will need to know all of your medications, so they can figure out which Part D plan will cost you the least.
Do Veterans Need To Sign Up For Medicare Part B & Part D?
This is a common question asked by many military Veterans. The Owner of Integrity Now Insurance Brokers is a 100% P&T disabled veteran, so he fully understand where this question is coming from.
Here is the short answer from the Veterans Affairs. Yes, you should sign up for Part B as the VA does not provide creditable coverage. You are not required to sign up for Part D as the VA provides creditable prescription drug coverage.
Now for our answer. As a Veteran, we know the VA has had its good times and its bad times. When funding is great, we obtain our needed services without much issues. But when the VA is under-funded this is where our Vets get left behind.
In addition, there are some VA hospitals that are well known for not offering quality care. While there are other VA facilities that are top notch in the care they provide.
By signing up for Medicare Part B, you will gain access, to being able to receive care from an outside provider. Even if your primary care VA doctor will not authorize community care, because you have both Part A and Part B, you can make the decision on your care for yourself.
There are Medicare Advantage plans that will exclude Part D coverages for Veterans, as they understand you have creditable coverage through the VA.
Lastly, if you live in an area that is hundreds of miles away from a VA facility, this will give you the freedom you may need. While you may qualify for community care based on the distance, we have heard some veterans struggling to get approval from their primary care VA doctor.
When considering your Medicare plan options as a veteran, make sure you fully understand the possible consequences of not signing up for Part B coverage.
Need Help FInding A Medicare Plan
Integrity Now Insurance Brokers understand the importance of having and receiving quality healthcare coverage. We have helped thousands of Medicare beneficiaries find a Medicare plan that works best for them.
As Medicare insurance brokers we act like a Medicare supplement plan, in that we have the complete freedom to help you sign up with any Medicare insurance company and Medicare plan that is available to you.
Are services are included at no cost to our clients. As a Medicare insurance agent we are paid directly from the insurance company we place you with. You pay the exact same no matter if you go through us or directly to the insurance company.
Please give one of our licensed and certified Medicare insurance agents a call today. We will help you find the best Medicare plan for you.