Healthcare Planning


Healthcare 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)
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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)
  • COBRA or COBRA continuation Coverage
  • Major Medical including; HMO’s, PPO’s and HSA compliant plans
  • Mini Medical including; Temporary and Limited benefit plans
  • Medicaid

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 COBRA or COBRA continuation coverage, most people do not select this option, unless they are either not insurable by another plan or the costs are very reasonable.
  • Major Medical including; HMO’s, PPO’s and HSA compliant plans can be the most comprehensive option offering many co-pay, deductible, networks for doctors and hospitals and a reasonable monthly premium.
  • For people in between employers or covering the time between retirement and medicare eligibility, a temporary plans may fit the bill.
  • 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:

  • Major Medical including; HMO’s, PPO’s and HSA is the most comprehensive and also the most popular. .
  • Mini Medical including; Temporary and Limited benefit plans, we suggest a comprehensive comparison of benefits side by side before a decision is made.