There can be so many different combinations of options to choose from when enrolling for Medicare, it can sometimes be overwhelming. Especially if you’ve been debating between traditional Medicare and Medicare Advantage, there are reasons why you may want to choose one plan over another. We can guide you through how to make the decision that’s right for you, along with how to choose a Part D plan, and what to do if you change your mind about any of it.
Traditional Medicare or Medicare Advantage?
If you’ve met the requirements and qualify for Medicare Part A, you won’t need to shell out for the monthly premium. You may be automatically enrolled in the program when you turn 65, but that doesn’t mean you can’t make the switch to Medicare Advantage.
Medicare Part B, on the other hand, does possess a monthly premium. You can accept or decline the coverage, but there could be penalties if you don’t enroll during your initial enrollment period. Unlike Medicare Part A, you won’t be automatically enrolled into Medicare Advantage coverage. Instead, you must first enroll in Medicare Parts A and B before you may add on the Medicare Advantage plan.
If you take prescription drugs, traditional Medicare won’t cover your prescriptions. For that, you need to enroll in Medicare Part D. Do you need to put a limit on your health spending? Medicare Advantage plans are legally required to cap yearly expenses which will prevent too many out-of-pocket expenses.
Anyone requiring vision or dental insurance should turn to Medicare Advantage. Traditional Medicare does not provide that coverage.
Do you want more variety in your health professionals? More doctors and healthcare providers accept Medicare than they do Medicare Advantage. If you need to see a specialist, Medicare Advantage sometimes requires authorization from a primary care doctor and seeing a doctor who falls outside of your Medicare Advantage network can cost extra.
How to Choose a Medicare Advantage Plan
If you are a current Medicare user, take a moment to read your Annual Notice of Change. This yearly document provides the information you need to decide if your current plan is working for you. You can view if and how your plan is changing.
If you need to choose a Medicare Advantage plan, look for plans with high satisfaction ratings of 3.5 stars or more within the Medicare website. Check out the fine print.
What’s the annual out-of-pocket cap if the worst should happen? Are your favorite healthcare providers part of the network in your prospective Medicare Advantage plan? Are dental and vision insurance provided? What about coverage for travelers? Be sure to compare and contrast the plans you are interested in to view how they fit into your life.
How to Choose a Part D plan
Do the prescription drugs you take appear on your prospective plan's list of covered medicines? Are there restrictions regarding the prescription drugs on your list? For example, does the prescription require authorized approval from the plan, are there drug tiers or are some drugs substituted for another?
If the plan you are considering doesn’t meet your criteria and makes getting the prescription drugs you need more difficult or costly to fill, you may want to reconsider moving forward with that plan.
What if I Change My Mind?
Mark your calendar for October 15th—December 7th, which is the date range of the Medicare Annual Election period when you can switch out plans. This is the perfect time to make changes to an existing plan and update your benefits.
Be sure to consider that if you make changes to your benefits during this period, copayments, coinsurance, and premiums can change on the first of each year, as can the costs associated with your Medicare Advantage plan or a Medicare Prescription Drug Plan.
If your desire to switch plans falls outside of the Medicare Annual Election period, you may need to wait until the next year. Plans can only switch outside of the term in special circumstances. Always make sure your plan works for you before the Medicare Annual Election period ends. Compare your current plan and your potential plan and see where your health needs fit.