Choosing the Medicare Plan That’s Right For You

It’s October in Oklahoma.

Spooky times of year

My mind turns to the pleasures of my favorite season. I love bonfires, cool days, and the beautiful foliage that marks the season. October is also a spooky month with kids excited to choose their costumes for Halloween.  Since turning 65 a few years ago, it's a bit scary for me when open enrollment begins for Medicare.

If you are new to Medicare a good place to start is by creating a profile.

Things to consider when choosing a plan

Medicare offers seven tips to consider when choosing a plan:¹

Costs:

Unless you have a fat 401 K which most retirees do not have, costs will be a major concern. My husband and I chose Original Medicare with a Medigap policy. Depending upon which type of plan you choose, you may have no out-of-pocket expenses or an annual deductible to meet. Medicare Advantage Plans are less expensive.

Coverage:

This is an important area to consider. Original Medicare covers services in hospitals, doctors' offices, and other health facilities. Medicare Advantage covers everything Original Medicare covers with some added benefits. They cover some of the cost of vision, dental, and hearing.

Your other coverage:

You may have other health coverage through a retirement benefit of an employer. Tribal members get health coverage through their tribal system or Indian Health Services. 

Prescription Drugs:

Original Medicare does not cover prescription drugs. You can choose Plan D coverage for prescription medications for an additional charge. Advantage Plans usually cover prescriptions.

Choice of doctors & hospitals:

With Original Medicare, you can choose any doctor or facility that accepts Medicare. Advantage Plans may require you to use a doctor or health care facility in their network.

Quality of care:

You really have to do your homework here to select a plan that fits your needs. On the medicare.gov website you can see every plan offered and which services covered. The plans are rated by consumers which is helpful when choosing your plan. 

Travel:

Neither Original Medicare nor Advantage Plans cover out of country travel. With traditional Medicare, your Medigap plan may cover travel.

Considering your options

If you are computer savvy you can do your own research into the various plans. If you need help, contact your local Agency on Aging and they will assist you in choosing a plan that fits your needs.

The cons

The disadvantages include provider limitations, copays, and lack of coverage if you travel.

In my personal experience, I have found that you also need to consider your geographic area. I live in the most impoverished county in Oklahoma. Many of my friends, feeling the pinch of paying for costly policies, have made the switch to a Medicare Advantage plan. It has had disastrous consequences for some of them. Few doctors in our rural area accept patients on an Advantage Plan. You must see a doctor in their network with limited choices. 

One friend with advanced macular degeneration now has to pay a $50 copay for each visit to the retinal specialist.  He also has a copay for each test or visit to the doctor. The “cheap” plan has ended up being the wrong choice for him.

The pros

Medicare Advantage offers added additional benefits and the convenience of one policy. Meanwhile, Original Medicare allows more flexibility in choosing doctors.

The takeaway

Whether you choose Original Medicare or Medicare Advantage, it’s important to consider all your health care needs and look at all the options before choosing your plan.