Shopping for a Medicare Plan

If you’re new to Medicare, learning about your options and choosing a plan may feel overwhelming. Arming yourself with knowledge is the first step. Your preferences, travel habits, health and finances all contribute to which plan is best for you.

Knowing Your Options

When looking at Medicare options, you first need to decide if you want to purchase an Original Medicare plan, Medicare Advantage plan or an Original Medicare plan with Medigap coverage.

• Original Medicare includes Part A (hospital insurance) and Part B (medical insurance) coverage. This type of Medicare is managed by the federal government.
• Medicare Advantage is a “bundled plan” offered by a private insurance company. These plans include Part A, Part B and usually Part D coverage, dental, vision and hearing benefits.
• Medigap is a supplemental insurance policy designed to fill the gaps in Original Medicare Parts A and B.

You can learn more about the parts of Medicare (Part A, Part B, Part C, Part D and Medigap), what they cover, and when you can enroll for each in this article.

Original Medicare & Medigap

With Original Medicare, you can visit any provider or hospital that accepts Medicare anywhere in the United States, and in most cases, you don’t need a referral to see a specialist or approval for coverage of services or supplies.

With Original Medicare, you pay for the Part B coverage upfront, and may want to also purchase Part D (prescription) coverage and/or Medigap. Medigap can help fill the gaps in Original Medicare. While Original Medicare covers services at 80%, Medigap coverage can help cover some of your other costs such as deductibles, copays and coinsurance. Paying for Medigap is typically a little bit more expensive than a Medicare Advantage plan.

Medicare Advantage

Medicare Advantage bundles all the parts of Medicare that you could otherwise enroll in individually.  Plans also often offer additional benefits, such as vision or dental coverage, that Original Medicare does not offer.

With a Medicare Advantage plan, you typically have a specific set of providers that are considered in-network. While this doesn’t give you the same freedom as Original Medicare to see any provider, this type of plan usually offers networks with high-quality doctors who can coordinate your care with other doctors in the same network. This creates a more seamless experience for you and positive outcomes for your health. Some plans even allow you to go out-of-network with prior approval.

Shopping for a Medicare Advantage Plan

Medicare Advantage plans are offered by private insurance companies across the United States. Here are several things to consider when selecting which Medicare Advantage plan is best for you.

1. Provider network. Check out their list of in-network providers and ensure any providers and/or hospitals that you want to continue visiting are in their network.
2. Prescription formulary. Every insurance company has a different prescription formulary that lays out what prescriptions are covered and at what cost. Take a look at their formulary to ensure that your prescriptions are covered.
3. HMO vs. PPO. Some Medicare Advantage plans offer HMOs, some offer PPOs and some offer both. HMOs have a narrower network of providers whereas PPOs have a larger network of providers. A PPO plan may be best for you if you travel often, or snowbird somewhere warmer for half of the year.
4. CMS Star Rating. The Centers for Medicare & Medicaid Services (CMS) rates each Medicare Advantage plan based on their overall plan satisfaction. Look for a plan that has four or five stars so that you can be confident knowing their current members are satisfied.
5. Extra benefits. Many Medicare Advantage plans offer extra benefits at no cost to the member, such as dental, eye care, hearing aids, fitness benefits are more. Determine which benefits are important to you and take them into consideration.

“Different supplemental benefits are important to different people,” shares Hilfinger. “One thing Paramount offers that our members love is a personal call center representative. This means that every time you call Paramount Elite (our Medicare Advantage plan team) with questions about your care, plan or coverage, you’ll talk to the same person who knows you and your history.”

One More Thing To Consider

When you turn 65, you are automatically approved to enroll in a Medigap plan if you so wish. However, if you choose to enroll in a Medicare Advantage plan and then later want to switch to Original Medicare with Medigap coverage, you may not be approved based on your health. If you are considering a Medigap plan, it is best to enroll in that coverage from the start.

Learn more about Medicare and the various plan options by visiting Medicare.gov.

Y0140_2024ShoppingArticle_M