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5 Questions to Ask When Choosing Your Medicare Coverage

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When you enroll in Medicare, you have options for the type of health plan you want. The first choice is whether to go with Original Medicare or to choose a Medicare Advantage Plan (Part C). If you decide to select a Medicare Advantage Plan, the next decision is which plan to choose. It is important to get answers to the right questions so you can make an informed choice and choose a health plan that suits your needs. The following are some questions to ask before selecting a plan.

Will I Have to Pay Premiums In Addition to Medicare Part B?

Whether you choose Original Medicare or a Medicare Advantage Plan, you will be required to pay Medicare Part B premiums. If you are receiving Social Security benefits, the premiums will be deducted from your benefit payments. Some Medicare Advantage Plans do not require you to pay any additional premiums, while other plans do. As a first step, find out how much a Medicare Advantage Plan will cost each month.

Can I Choose My Own Healthcare Providers?

The leeway you have in selecting providers will depend on the type of plan it is. With an HMO (Health Maintenance Organization), your coverage is limited to care by providers within the plan’s network. Typically, HMOs will only cover out-of-network care in emergencies. With a PPO (Preferred Provider Organization), you have access to a local network of doctors and hospitals, but you still have the flexibility to see other doctors that participate in Medicare and accept that health plan. However, your copay could be higher if you go out of network. Before choosing a Medicare Advantage Plan, find out if your doctors are in that plan’s network.

What Will My Out-of-Pocket Costs Be?

Find out about deductibles, copays, and co-insurance before enrolling in a Medicare Advantage Plan. Unlike Original Medicare, Part C plans set a cap on out-of-pocket expenses for each calendar year – meaning after you spend a certain amount for covered medical costs, you will not be required to pay any more out-of-pocket for the remainder of the calendar year. You should know what the cap is for a plan you are considering in case of a serious illness or injury that requires extensive medical treatment.

What Benefits Does the Plan Offer?

Some Medicare Advantage Plans offer prescription drug coverage plus vision, dental, and hearing. Although some plans that offer these benefits charge additional premiums, some do not. If a plan does not offer prescription drug coverage, you can join Medicare Part D.

What Access to Healthcare Will I Have?

What is the health plan’s service area, and do you have coverage for care received outside of that area? Is a referral from a Primary Care Provider (PCP) required to see a specialist?

If you are selecting a Medicare Advantage Plan, our friendly agent can assist you with the process by explaining your options and helping you find answers to the right questions.

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