Steps for Picking a Medicare Plan

Making the move from private, employer-provided health insurance to Medicare can be a daunting task. First, there’s the new lexicon: Medicare Advantage, Part B, Part D, Medigap — what do they all mean? Then there’s the fear. After all, the health care decisions that you make at this pivotal time can affect your out-of-pocket medical costs for the rest of your life and determine which doctors and other medical professionals you can see.

It’s a lot of pressure. But with some research and careful consideration, you can find a Medicare plan that works for you. Here are the steps you should take to make the right choice for your health and budget needs.

[Read: Medicare and Medigap: What’s the Difference?]

How to Pick a Medicare Plan

Check your timing

According to Diane Omdahl, co-founder and president of 65 Incorporated, a Medicare education company, most people need to enroll during the initial enrollment period, which is the seven months surrounding one’s 65th birthday — including the three months before your birthday month and the three months after. Patients may be responsible for late penalties and lapses in coverage if they neither apply for Medicare during this period nor qualify for a special enrollment period, which allows people to enroll outside of their 65th birthday window following unplanned events, such as job loss.

But for those still working, there’s often no need to enroll.

“There is a perception that you must enroll when you turn 65. That is true except with people still covered by an employer plan,” Omdahl says. Federal law says that an employer group health plan (sponsored by a company with 20 or more employees) can be the primary carrier, regardless of age. She points out that people working at 65 or past 65 make the most mistakes with enrollment.

For those already enrolled, the annual open enrollment period, which runs from Oct. 15 until Dec. 7 each year, is the best time to consider switching plans or adding coverage.

Learn about your options

There are two types of Medicare coverage: original Medicare and Medicare Advantage. According to Medicare.gov, original Medicare is a government-provided, fee-for-service plan that is made up of two parts: Part A is hospital insurance and Part B is medical insurance.

After you pay a deductible, Medicare pays its share of the approved amount, and you pay your share through coinsurance and deductibles. Prescription drug coverage requires signing up for Medicare Part D, with an additional premium. There are also supplemental policies, known as Medigap policies, which can cover certain benefits not covered by parts A and B, such as vision and dental care.

Medicare Advantage is a plan offered by a private insurance company that contracts with Medicare. These plans include Part A and Part B coverage. They also typically include prescription drug coverage and may offer vision, dental and other services.

[READ: When to Make an Emergency Dental Visit.]

Look closely at prescription drug coverage

Studies find that too many Medicare eligibles fail to choose the least expensive drug plan and overpay by hundreds of dollars a year. When researching plans, keep all of your current medications handy.

“I find that when people call us, they often don’t have their medication names, dosages or frequencies,” says Tatiana Fassieux, a training and education specialist for California Health Advocates, a Medicare advocacy organization. And every year, plans change where drugs are placed in their payment tiers and which pharmacies they work with to offer the best prices. Check your plan’s formulary carefully each year to see what may have changed. Medicare.gov also has excellent price comparison tools.

“Don’t be complacent,” Fassieux says. “If a person doesn’t proactively review prescription drug coverage, or in the case of a Medicare Advantage plan — the entire benefits package, in the end it can cost them hundreds if not thousands of dollars.”

Pick your plan

“If you are new to Medicare, your first decision is a simple fork in the road,” says Andrew Shea, senior vice president of insurance marketing at BetterCare, an insurance agency. “Do you want original Medicare or an Advantage plan? They are very different plans. Each has pros and cons.”

Of course, the monthly premium is one important factor when choosing a plan. But there is much more to it than that, according to 65 Incorporated:

Other costs: What are the out-of-pocket costs, like copays and deductibles?

Coverage: Is there coverage for all your physicians, medications and required services?

Quality: How does Medicare rate the plan, in terms of customer service, fairness of appeals and other important factors?

Another major consideration is future possibilities. What if you found out that you have a major illness next year? Would the plan that you are considering still work well for you?

[Read: What to Consider When Shopping for Medicare Coverage.]

Enroll

If you are new to Medicare, you first need to enroll by:

— Going to https://www.ssa.gov/benefits/medicare/.

— Calling Social Security at 1 (800) 772-1213 (TTY 1-800-325-0778) 24/7.

— Visiting a local Social Security office.

Who Can Help Me Choose a Medicare Plan?

Next, decide who you want to work with to choose your plan — an insurance agent or broker, or the insurance company directly.

The best way to wade through these differences is to work with a Medicare expert.

“Our strong belief is you need to work with someone who understands senior insurance really well and can help you weigh the pros and cons,” Shea says. “You don’t want a jack of all trades who sells you home and auto insurance and, oh by the way, also has medical insurance if you want it.” Note that brokers are not required to offer all plans or inform people about all their options.

The premiums are set by Medicare or the insurance company if you select a Medicare Advantage or Medigap plan. Medicare premiums do not change regardless of who you work with, but the other plans vary among companies based on the state they are licensed to do business. Your State Health Insurance Assistance Program provides assistance and advice to all Medicare-eligible individuals and their families or caregivers.

More from U.S. News

Medicare vs. Medicaid: What Is the Difference?

Medicare vs. Medicare Advantage: How to Choose

What to Do When Your Doctor Leaves Your Health Plan

Steps for Picking a Medicare Plan originally appeared on usnews.com

Update 06/08/22: This story was previously published at an earlier date and has been updated with new information.

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