The most important part of shopping for Medicare insurance is understanding each of the options made available to you. To learn more about Medicare insurance options and combinations, read this section.
Reflecting on past insurance plans and current desires for a health insurance plan is crucial when picking which plan suits you. To find questions that will guide your insurance plan evaluation and reflection, read this section.
Since there are so many Medicare insurance options to choose from or combine, comparing plans can aid a patient with their decision. To find resources that compare various Medicare insurance options, read this section.
Once most United States citizens turn 65, they become eligible for Medicare which is insurance provided through the United States government. Citizens who are dealing with certain disabilities may qualify for Medicare prior to age 65. Social Security is what originally enrolls a citizen in baseline Medicare insurance, however, there are a variety of options and combinations to choose from when getting a new Medicare insurance plan.
Step One: Understand Your Options
Before choosing which insurance plan is suitable, one should understand what options are available to them.
Parts of Medicare
Medicare breaks down into three parts: Part A, Part B, and Part D. Part A provides hospital insurance, e.g., inpatient hospital care, home healthcare, nursing home care, and hospice care. Part B offers medical insurance for necessary medical or preventive care services, e.g., vaccinations, outpatient check-ups and procedures, mental health screenings, durable medical equipment (DME), and more. Finally, part D provides prescription drug coverage.
Medicare Plan Options
There are various plans to choose from or different combinations to make to get the coverage you need. All of the options to select from include: Medicare, Medicare Advantage, Medicare-Medicaid, and MedSupp.
Standard Medicare includes both Part A and Part B coverage, leaving the patient responsible to make up for any gaps in coverage such as prescription drug expenses, dental or vision insurance, and any deductible costs.
Otherwise called “Part C”, Medicare Advantage plans include Parts A, B, and D coverage in addition to various other benefits such as insurance for dental, vision, and hearing. This is often known as Part C coverage because it works to cover the gaps of what standard Medicare offers.
Medicare Advantage plans also break down into various types e.g. HMO, PPO, SNP, and more. Different types of plans provide different benefits and include distinct networks of providers and hospitals. Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans are the two most common types that are chosen. To learn more about plan types and the pros, cons, and overall differences between them, visit this source.
Medicare and Medicaid differ in the sense that Medicare is a federally funded health program for seniors or those with disabilities and Medicaid is a state-funded health program for lower-income households. That being said, these insurance programs can be combined for a patient and are commonly called “dual-eligibles”. When they are paired together, Medicare takes place as primary insurance while Medicaid functions as secondary insurance. This plan includes no premiums while offering Parts A, B, and D coverage in addition to various benefits such as insurance for dental, vision, and hearing. However, in order to select this plan, one must qualify for Medicaid coverage.
Medicare Supplement Insurance, commonly called “Medigap” or “MedSupp”, is sold by private insurance companies to help patients cover the gaps in standard Medicare insurance. Medigap typically comes with higher monthly premiums than Medicare Advantage plans.
Step Two: Outline your Insurance Wants and Needs
Once your options are laid out and understood, it’s time for a patient to reflect on which aspects they want and need out of an insurance plan. To start, make sure any preferred providers (doctors, specialists, nurses, etc.) accept the insurance plan you’re leaning towards. Furthermore, think through past insurance plans and their pros vs. cons. Doing so will help a patient to see what their past plans were lacking in or succeeded at, thus helping them understand what they desire out of an insurance plan now. When meditating on what you want and need out of a Medicare plan, use these questions to guide your mind:
How much are you willing to contribute monthly to insurance (health, dental, vision, etc.)?
What’s a good range for your deductible to be at?
Does a package deal of prescription drug coverage, dental insurance, vision insurance, and added benefits hold importance to you?
Do you qualify for Medicaid, thus would you be eligible for a dual-eligible plan?
Are your preferred providers and hospitals included in your network?
Is transportation to and from the provider’s office necessary for you? If so, check and see if this is included in your plan.
Is it important for your plan to include mental health and wellbeing benefits?
Step Three: Compare Your Options
Once ideal insurance plans are narrowed down, the patient should compare their options in order to decide which Medicare plan is right for them. If struggling to find plans in your area or simply want to compare insurance plan options, visit one of the sources below:
Step Four: Speak With an Agent
Insurance can be tricky and confusing to understand. If further assistance is required or questions are left rattling inside a patient’s brain, speak with an insurance agent. Even if a patient feels like they have a strong, general understanding of their options and which plan is right for them, it’s good to speak with an agent to ensure they know what they’re signing up for. To schedule a time to talk with a Medicare insurance agent, visit one of the sources below:
Step Five: Purchase Your Plan
The final step in shopping for a Medicare insurance plan is purchasing the plan you feel is the best fit for you. Visit the government’s Medicare website to explore the plan you want and enroll in it when the time is right.
Note: One of the benefits of Oak Street Health is that they have agents ready and available to talk any patient through their Medicare plan benefits. If a patient ever needs a refresher on what their plan offers, schedule a call with an Oak Street Health provider.
HMO and PPO insurance plans are the two most common health care insurance plans in the United States. With roughly 70 million American’s having an HMO plan and almost 90 million American’s having a PPO plan, these managed care services are the predominant form of healthcare in America.