Medicare planning is the process of effectively selecting the appropriate plan of care that matches your healthcare needs and financial resources.
We suggest the following process.
Step 1 - Review all available options before you read any material provided by an insurance company:
- Group Health Insurance (with our without Medicare parts A and B)
- Medicare parts A and B only
- Medicare parts A & B and a Medigap plan (The paring result in a Medicare Supplement)
- Replace your Medicare parts A & B with a Medicare Advantage Plan (Medicare; HMO, PPO, POS or PFFS)
- Medicaid (Medicare parts A & B and Medicaid is referred to as dual eligible)
Step 2- Research and Compare Medicare plan options (not insurance plans) side by side to see which are available to you specifically
- Group Health Insurance (with our without Medicare parts A and B)
- Medicare parts A and B only
- Medicare parts A & B and a Medigap plan (The paring result in a Medicare Supplement)
- Replace your Medicare parts A & B with a Medicare Advantage Plan (Medicare; HMO, PPO, POS or PFFS)
- Medicaid (Medicare parts A & B and Medicaid is referred to as dual eligible)
Step 3 - Narrow down the options to one or two now you need to plans offered within the options:
- If you selected remaining with your group plan consider the premium cost, co-pays, deductibles and the out of pocket maximums you will be responsible for on an annual basis.
- As for Medicare parts A & B alone, most people do not select this option, but if you do, carefully consider the unlimited out of pocket costs you be responsible for annually.
- Medicare Supplements can be the most comprehensive option offering no co-pay, no deductible, no restrictions on doctors or hospitals and a reasonable monthly premium in addition to Medicare parts A & B.
- In many zip codes around the country, Medicare Advantage plans offer a great deal of value and protection. These plans use networks in most cases and have co-pays, deductibles and annual out of pocket maximum costs now capped at no greater than $6,700.
- Medicaid is a state and federal partnership (often renamed by individual states; AHCCCS in Arizona, MediCAL in California). This results in cost of care from completely free to 20% co-pay depending on the level of benefits you qualify for based on income.
Step 4 - When you have selected (or qualify for) a particular option, the next steps could include:
- If you selected a plan with networks, then you need to check the provider directories of each available plan to see which plans your doctors participate within. (Skip this step if you selected Medicare parts A & B and a Medigap plan F, you can use any doctor or any hospital in the U.S. without restrictions)
- We suggest checking at least 5-7 networks prior to moving to the next step.
- Once you have found 3 to 5 networks your physicians participate within, move to the next step.
Step 5 - Compare benefits and premiums:
- Medicare supplements (Medigap) are federally standardized. Plan F is the most comprehensive and also the most popular. You can select a Medigap plan F from BlueCross and feel completely comfortable they are federally required to offer the exact same benefits from the Medigap plan F from ACME insurance or United Healthcare.
- Medicare Advantage offer a federally standardized schedule of benefits but the co-pays and deductibles and locations where service is rendered is completely different. We suggest a comprehensive comparison of benefits side by side before a decision is made.