6 Key Factors to Consider When Shopping for a Medicare Plan
There are many things to consider when it’s time to choose a Medicare Plan.
- How much are your premiums, deductibles, and other costs?
- How much do you pay for services like hospital stays or doctor visits?
- Is there a yearly limit on what you could pay out-of-pocket for medical services?
- Which doctors and hospitals do you need access to?
- What prescriptions must be covered?
- Can you qualify for extra help?
By working with a local Plan Advisor, we give you unbiased access to all the available options in your community. We also make sure you understand each of the options, and keep you informed of new plans or changes to existing plans occurring each season. Let us share a little more about the important points we will review in order to help find the Medicare plan best suited for you and your loved ones.
With Original Medicare there’s no limit on out-of-pocket cost per year, unless you have supplemental coverage or a Medicare Advantage Plan. Out-of-pocket costs should also include your premium, which is often overlooked in the equation. Your Plan Advisors Hawaii representative will help calculate the financial exposure of each option, so you can feel confident the plan you choose fits your budget and risk tolerance.
Since so many details surrounding cost are covered in documents beyond the benefit summary (outpatient surgery, imaging, etc), we will review the Evidence of Coverage in order to gain a complete understanding of the costs associated with each benefit. We will also review the Annual Notice of Change that your plan sends you each year, prior to the start of each enrollment season, in order to determine whether the current plan is still best suited for your needs.
The EOC gives you details about what the plan covers, how much you pay, and more. If you did not receive an overview of the EOC and/or ANOC, a Plan Advisors agent will be happy to order one and review as part of the initial consultation.
Medicare Supplements and Medicare Advantage Plans all offer coverage beyond that of Original Medicare. Medicare Supplements combine with Medicare alone by filling in the gaps of Original Medicare. For Medicare Advantage, each plan filed must cover, at a minimum, the actuarial equivalent of all the services Original Medicare covers. Most do far better than this minimum requirement. Some plans offer ancillary benefits that Original Medicare doesn’t cover – like vision, hearing, or dental. By helping you understand the pros and cons of each option, you’ll be confident in the selection you make each year.
Prescription drug coverage is a vital component to your plan of choice, not only for the coverage it provides, but in order to avoid penalties and fees according to the CMS regulations. Whether you take prescription medicines or not, CMS requires you to have minimum drug coverage. This can be obtained via Part D stand alone plans, Medicare Advantage Plans, or what CMS deems “creditable coverage” like employer benefits, retiree plans, or veteran coverage.
When you meet with your Plan Advisor, we will run a calculation with the Medicare.gov Rx Tool, taking your specific medications into account, ensuring they are covered under the desired plan formulary, and in an affordable tier. We will also help you apply for extra help or other available subsidies to cover the costs of medicines, as there are several resources and programs we can apply for. For prescriptions alone, it pays to schedule a consultation with a local Plan Advisor.
Doctor and Hospital Choice
Plan Advisors Hawaii Agents will always start with helping you find a plan that your desired Doctors and Hospitals accept. Furthermore, we will confirm that your primary care physician is able to refer to the specialists you wish to see.
Some plans offer out-of-network coverage. For out-of-network physicians we will help confirm that those providers will accept your chosen plan as an out of network benefit. This is yet another important feature that our local agent will provide for you.
Quality of Care
The quality of care and services offered by plans and other health care providers can vary.
Medicare Advantage plans are now graded on certain quality scores by CMS, known as Star Ratings. A Star Rating is like the reviews you may read about with a local business or vendor. Your Plan Advisors Hawaii agent will show you the star ratings for each plan of interest and the components that go into these grades.
It is important for you to know the star ratings as they also impact the funding of your selected plan, which may impact plan stability. Physicians are evaluated by HEDIS scores, which is another quality metric that your local agent can use to help you evaluate the plan’s network. Quality outcomes by plans and providers equals more satisfaction from its members and patients respectively.
Original Medicare generally doesn’t cover care outside the US. If coverage during travel is important to you, be sure to share this with your Plan Advisors agent during the visit. Certain supplements that are no longer for sale, but are grandfathered in for those who currently own them do have travel features. Most Medicare Advantage plans cover emergencies or urgently needed care services outside the US. Whatever your interest, a local Plan Advisor will go over your travel destinations and find a plan that travels with you.