10 Key Considerations for Medicare Beneficiaries
Getting the right Medicare coverage means getting on the right Pathway – Original Medicare vs. Medicare Advantage – and then tailoring the coverage for your personal needs. Consideration of the top factors for successful Medicare plan selection is a necessary first step.
1. Consideration: Residence
Discussion
Many Retirees have multiple residences, and places where they can live. Medical Supplements are available on a state-wide basis, Advantage plans by county and zip code. Availability varies tremendously with geography – consider residence venue when selecting Medicare options. Residence has a limited meaning for Social Security and Medicare – take the time to understand how it can impact you and learn more here.
Impact
For Supplements, considerations include availability and cost. Advantage plan considerations include availability, cost, and benefits. Work with a broker who can help in all the relevant markets.
2. Consideration – Supplement vs. Advantage Plans
Discussion
Supplements provide important coverage for costs not covered by Medicare at a fixed price per month. Advantage plans have more complex billing, but limit risk and offer expanded benefits.
Impact
Supplements are very common for young retirees who value travel and fixed cost. Supplements costs increase with age, making the lower monthly cost and increased benefits of Advantage plans appealing.
3. Consideration – Coverage for hearing aids, vision correction, dental and other health need
Discussion
Many Advantage plans offer expanded coverage for hearing, vision, OTC products, dental, meals, transportation, and other health needs. Supplements may offer access to discount programs but cannot provide comparable benefits.
Impact
It is critical to understand the amount of benefit and access (if limited to network providers). These can be valuable benefits, but they are also a point of frequent confusion and frustration and need to be weighed against the rest of the coverage offered by the plan. A single benefit should never be the reason to choose a plan.
4. Consideration – Provider and facility access
Discussion
Access to desired providers and facilities is a generally ubiquitous with Supplements. It is a key point with Advantage plans and a point of frequent problems. PPO and POS plans generally offer much expanded selection, and some Advantage plans now offer nationwide networks.
Impact
Access is frequently limited by networks and prior authorization. Advantage plans differ materially in access, so understanding plan specifics is critical.
5. Consideration – Access to Emergency Care in the US
Discussion
All Supplements and Advantage plans offer unlimited access to emergency care in the US. Certain Advantage plans now offer unlimited access to urgent care as well, which allows for easier care access in non-critical situation.
Impact
The expansion of nationwide networks and urgent care has been a benefit increase for many Advantage plans that can benefit frequent travelers in the US.
Some Medicare Advantage plans offer great coverage for extended trips outside the US.
6. Consideration – Access to Emergency Care outside the US
Discussion
Supplements D, G, M, and N offer a lifetime benefit of $50,000 with a 20% co-insurance for trips less than 60 days. Many Advantage Plans now offer unlimited emergency and urgent care coverage for extended trips with limited co-pays from beneficiaries.
Impact
Supplements offer reasonable coverage for short trips; some Advantage plans offer great coverage for extended trips outside the US.
7. Consideration – Drug Coverage
Discussion
Part D drug plan coverage can be purchased separately with Supplements and are now included with most Advantage plans. Benefits and prices vary by plan, drug, amount purchased, aggregate spend and location of purchase.
Impact
Drug plans are great for certain drugs and offer great catastrophic coverage. Drug plan prices and formularies can change during the year, so accurate planning is difficult.
8. Consideration – Risk Mitigation: Advantage plans
Discussion
Advantage plans normally include co-insurance and co-pays for certain services, but all plans must cap total out-of-pocket per beneficiaries to $7,550 (HMO) and $11,300 (PPOs). Many plans have limits much below these levels.
Impact
Maximum out-of-pocket is the main risk mitigation tool for Advantage plans, and it varies by plan.
9. Consideration – Risk Mitigation: Supplements
Discussion
Most Supplements cover all areas of Medicare costs. Plan G is the most popular plan and covers all Medicare-covered expenses other than the Part B deductible ($233 per year). Coverage can leave “holes”, so understand what risk you are covering or assuming in any plan you consider.
Impact
Supplements offer wonderful coverage but can leave holes. For plans involving coverage holes, there is no out-of-pocket maximum comparable to Advantage plans.
10. Consideration: Know your options
Discussion
Medicare Advantage and Part D Drug plans change every year. Pricing for Supplements changes every year. Take a few minutes every year to know your options.
Impact
Most Medicare beneficiaries needs change episodically, and Medicare Plans change every year. Whether you are a traditionalist in Original Medicare, or a wrapped in the security of an Advantage Plan, take the time each year to consider your needs and options. Make an informed decision. Give us a call to set up a meeting.
