How to Pick A Medicare Plan That’s Right for You

Susie Valentine
 • 
Nov 20, 2020
 • 
10
 min

Reclaim your health with us! This article discusses choosing a Medicare plan and covers:

  • Where can I find the best information about Medicare?
  • How to review your medical history before you choose a Medicare plan
  • The questions you should ask yourself before choosing a Medicare plan
  • What do all the different Medicare plans cover?
  • Which Medigap plans are most popular?
  • What does it mean if you’re dual eligible?

It can be overwhelming to choose a Medicare plan that’s right for you. With so many plan options, keep in mind that no matter what plan you pick, Medicare will let you change it if you are unhappy or find out later that your physician does not accept your plan.  Remember, the Red, White, and Blue card is a health insurance plan that you will always have no matter what.  It is costly, but no one can take it from you once you qualify. 


How to Review Medicare Plans

If you are not “aging in” or have a special enrollment need such as moving across the country or getting out of jail, you pick your Medicare plan every Fall during “open enrollment”.  This usually falls between October 15th and December 7th.  You can go to Medicare enrollment meetings (you will get postcards from all the carriers offering plans in your area, or you will see commercials), research your options online, or call 1-800-Medicare to see what plans/meetings are offered in your area. 

The very first thing you want to do is look back at the last year or two and take a really good look at your medical history.  Did you go to the doctor often?  How many specialists did you see last year?  How many prescription drugs did you take?  Do you have an elective surgery coming up, such as a hip or knee replacement?  Write everything down--even the trips to Urgent Care or the Minute Clinic for the cold or flu.  Do you have a Primary Care Physician?


How Much Would It Cost Under Each Medicare Plan?

It’s helpful to plan out what your year of medical care might look like. Perhaps you’ve discussed having an elective surgery with one of your healthcare providers. Perhaps you recently switched prescriptions and the new regimen is working really well for you. For example, if you are a considerably healthy person, 65 years or older, you exercise, schedule your annual physical, then your two-year look-back should be relatively easy.  Maybe you went to your PCP in the last year for a cold or the flu, but you do not have diabetes, COPD, or any other chronic disease.  This is a great example of someone who should be looking into Part C plans, or Medicare Advantage Plans.  You will pay a premium for a Medicare PPO plan, ranging from $80 to $150 or you may choose a zero premium Medicare HMO plan.  These plans have small copays for a primary care physician office visit, a slightly higher copay for a specialist, and a per day deductible for hospital stays.  This would be the only money you would spend besides the Part B Premium. 

Another example where a Medicare Advantage Part C plan makes sense is if you live in a large metro area and know there are several health systems that take the plan you pick.   Your family physician may be an employee of one of these larger hospital systems.  Family practice physicians have an extremely hard time making it on their own, so they join larger health systems to help keep the lights on so they can continue to care for their patients the way they need to.


How Complicated is Your Health Care?


It’s important to be honest with yourself and ask how complicated and involved your health care is. This will help you decide on how comprehensive or extensive of a Medicare Plan you should consider.

For example, if you go to the doctor several times a year, see several specialists, and have a chronic condition such as diabetes or congestive heart failure, a Medigap plan is something to consider.  Remember, Medigap plans run letters A through M.  Some are just for catastrophic coverage (major inpatient hospital stays), but the most popular and highly desirable plans are usually considered Plan F or Plan G.  These plans have to be the same across the country, and the only changes private insurance companies can make is in the price based on where you live or your status as a smoker or non-smoker.  Go to Medicare.org and type in your zip code for Medigap plans to see what is offered in your area.  You may pay up to $170.00 for the higher end Medigap plan, however you will not have a copay, deductibles, or coinsurance.  If you have a Medicare approved procedure, the Medigap plan will pay your portion that the Red, White, and Blue card leaves you. 

Don’t forget, Part A is automatically given to you if you paid 10 years (or 40 quarters) into the system while you were of working age.  Part B has a premium which is currently $144.60 and higher if you are in a really high-income bracket, and this money comes out of your social security check before you get it from the Federal Government.  If you pick a Medigap Plan, the letter that covers all expenses so you do not ever receive a bill, you will pay an additional $175.00 on top of the $144.60.  Then, you will need to include a Part D prescription drug plan which can cost up to $65.00 a month depending on the carrier you choose. Your total cost for the month? $384.60 (or 4600.00 for the year).

If you go with a Medicare Advantage Plan with Part D included, you would pay the Part B premium, then the cost of the plan you choose, either a Medicare PPO or Medicare HMO plan.  These can cost up to $175.00 a month as well but they have perks such as gym memberships, free eye wear, acupuncture, or free vitamins, which are not included in Medigap plans.  Even if you are lucky enough to find one at a zero premium, you will still have your copays, deductibles, and coinsurance.  An average Medicare enrollee will pay approximately $6,000.00 out of pocket in 2020.  This includes premiums, deductibles, coinsurances and uncovered expenses.  The best question to ask yourself is: would you rather pay everything upfront (Medigap) or pay after your doctor bills you copays, deductibles, and coinsurance--but with perks, such as a fitness membership (Medicare Advantage with Part D)?  


Other Ways to Keep Medicare Costs Down

Keep in mind you can keep cost down if a good deal of homework is done on your part.  Ask questions, find out which carrier in your area is offering Medicare Advantage or Medigap plans.  Do some price comparisons.  Once you have narrowed your choices down to three insurance names you recognize, make sure your physicians take the plans.  It is heartbreaking to say the least when you pick a great plan and your doctor is not in the network with that particular carrier.  You can check this by either calling your primary care physician and specialist, or by going to that carrier’s website and checking the network of providers in your area.  The carriers are mandated to send out directories upon request.  Sometimes, physicians sign up at the last minute and may not make the directory printing.  Your best course of action is to call your list of physicians. 

One other thing to consider is if you are dual eligible or not.  If your Medicare (Social Security) check is on the lower side, you may qualify for Medicaid on top of your Medicare.  This is known as being “dual eligible.”  Qualifying for Medicare and Medicaid is nice because you do not normally see any doctor bill what-so-ever.  You can ask Medicare when you call 1-800-Medicare if you qualify.  Your social security check has to be in the $600.00 range or lower in order to be dual eligible. 

Let’s look at some questions:

  • What if I have a frequent interaction with doctors and hospitals?   How much would I pay under Plan A and B?   This is a great question.  Remember, Part A is free once you turn 65 if you paid 10 years or 40 quarters into the system.  If you have never worked outside of the home, then you qualify for your spouse’s benefits.  Part B requires you to pay a premium and a deductible.   
  • How much do I pay if I add a Medigap plan? How much do I pay under a Medicare Advantage Plan?  Medigap plans range in price based on your geographic area and if you are a smoker or non-smoker.  The top Medigap plan that covers everything is going to be more expensive than the catastrophic plan that only helps with inpatient hospital stays.  Medicare Advantage Plans range in price as well based on PPO or HMO, and the work you have to do to stay in your network of providers.  Medigap plans may be expensive on the front end, but you do not have a copay or a coinsurance on the back end.  Medicare Advantage Plans have copays and a coinsurance; however, the perks are nice even if you are a semi-active senior.

If you are on the healthier side, a Medicare Advantage plan can save you money.  The nice thing is that if you do have a bad year, you can change your Medicare plan during the next open enrollment.  One thing we do know is that original Medicare, just the Red, White and Blue card is not enough.  The deductibles are simply too high even if you have just one hospital stay (over $1,000 dollars).  Picking a Medicare Advantage Plan or a Medigap plan is a necessary cost in order to keep your overall medical cost down.