Choosing Your Medicare Insurance Plan
1/23/2023
If you are turning 65 soon, or you are on Medicare already there are a lot of factors to consider when choosing your plan.
Key factors to consider are:
• Which side of Medicare do you want? Original Medicare or MA/MAPD?
• Do you want a specific carrier, or to see all options?
• What prescriptions do you take? What pharmacy do you use?
• Who are your providers for medical, dental and vision?
• Do you have health concerns?
• Do you travel frequently?
If you are already on Medicare Advantage (MA) or a Medicare Advantage Prescription Drug plan (MAPD), you should be reviewing your plan regularly to make certain that your preferred providers are still in network, and that your prescriptions are still offered in an optimal tier. These plans change frequently, and their drug formularies change as well. So, whether the plan changed, your needs changed, or you moved to a new area, these things all may justify a switch. As a result, there are many opportunities throughout the year to switch, such as Open Enrollment (Oct 15—Dec 7), and the MA Open Enrollment (Jan 1—Mar 31) to name a few.
If you are on a Medicare Supplement plan, you can change any time of year, without limitations. People might do this because they get premium increases, or have moved to a new area, or want to move to the MA/MAPD side of Medicare.
FACTORS IN CHOOSING YOUR PLAN
One of the things you might think about first is… do you have a preferred insurance carrier you want to stick with? Some people have more trust in one carrier over another, so they base their decision on a big name. Other people want to see what the current plans looks like across all carriers, so they can evaluate and weigh which company to go with.
By insurance carrier, we refer to … Cigna, UHC, Humana, BCBS, Wellcare, Aetna and so on. They are big insurance companies.
On the MA/MAPD side of Medicare, these big carriers have been contracted with the Federal Government to offer plans. The carriers must adhere to strict guidelines set forth by Centers for Medicare & Medicaid Services (CMS).
On the Original Medicare side, there are carriers that offer Medicare Supplemental programs, which cover the 20% gap in the Original Medicare program. Original Medicare pays 80%, leaving a 20% gap for you. The Med Supp plans cover that gap, with a premium. All Med Supps are federally mandated to have the exact same benefits from one carrier to the next, but the difference is premium price. It’s a little bit like, “pay up front “and have an open choice of doctors at your leisure, even when you’re travelling.
On the other hand, Medicare Advantage is typically zero premium, but they are often constricted to an HMO network. With a zero premium, it’s a lot like “pay as you go,” because although you have no premium, you will generally pay a copay when you visit a provider.
USING AN AGENT
The next thing to consider is using a licensed Medicare agent to assist you in your evaluation. There are two types of agents. Captive and Independent agents.
Captive agents work directly for one insurance carrier. Since they are employed by that carrier, they cannot recommend other plans. If for example, you know that you want to be on an Aetna plan because you like that company, then you would utilize an Aetna agent to assist you in choosing which Aetna plan is best for you.
Independent agents are generally licensed with all carriers (or sometimes just the major ones), and they do not work for any particular carrier directly. So, if you are carrier agnostic, and you want a broader perspective, you might want to select an Independent agent to assist you, who is not captive with any particular carrier. These agents can review everything offered in your area from all carriers, and compare and contrast each plan with your specific needs to make a recommendation.
This article contributed by Nanette Makrauer of Health-Wealth Insurance, Independent Agent offering consulting services for Medicare/Medicaid, Under 65 Health Plans, Small Group, Dental and Vision, LTC, and Tax-Free Retirement. “Each person I consult with receives personalized service resulting in the best possible plan(s), for their needs.” Phone: 602-550-1335; Email: nanette@health-wealth-insurance.com; Website: www.health-wealth-insurance.com