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How Do You Choose the Best Medicare Plan?

confused choosing a Medicare plan

If you are on regular Medicare Part A and Part B, you will want to review your supplemental policy (if you have one). While the monthly premium you have to pay for a Supplemental Health Plan is typically more expensive than you would pay for a Medicare Advantage Plan it often provides you more choices in healthcare providers and greater coverage towards payments, and covers co-pays, etc. You usually get to select your healthcare providers and change healthcare providers whenever you want. You can choose whether to use community physicians or the specialized university medical system. You can choose the rehabilitation center you want or the mental health treatment center you want. The gamble is whether you get sick or not. If you get sick your premium will feel reasonable when you see what your care would have cost if you did not have the insurance coverage. If you do not get sick, it feels like you wasted a year’s worth of premium payments that could have been used for something fun.

This is where the personal part comes in. We all have to decide what our priorities are and how we want to spend our money. The Medicare Advantage Plans often are less expensive on a monthly basis and include expanded coverage for items Medicare A and B do not cover. Many Medicare Advantage plans have contracts with healthcare providers, limiting their plan coverage to those providers. The contract may limit which hospital, rehabilitation center, mental health provider, physician, just about any type of healthcare provider you may use. It is up to you to decide if you are going to be content with the limitations. You will be “stuck” with the plan you have chosen until the next open enrollment period.

Confused? Call an Aging Wisely Expert for help!

The Medicare Advantage plans may change their healthcare provider contracts at any time. It is your responsibility to review their website and keep up to date on any changes. Sometimes your healthcare provider will contact you and state “After next month I am no longer part of your insurance plan.” When this happens you have to decide whether to pay for out of network coverage or change to a healthcare provider covered by the plan.

Some people can live with the changes, go with the flow, and are able to change healthcare providers without being upset. They do not feel limited by only having certain healthcare providers to select from.

Most healthcare providers in Florida accept Medicare assignment. This means the healthcare provider agrees to accept the payment determined by Medicare. This does not eliminate your need to meet a deductible or pay a co-pay. We are fortunate in Florida. In many states there are plenty of private insurers and patients covered by insurance provided by employers. The reimbursement to healthcare providers is more significant than the reimbursement Medicare pays. So, many healthcare providers in other states choose to not accept Medicare.

If your healthcare provider only participates with certain insurance plans it is not an indicator that they are good or bad. You should not feel like you have poor choices if you are limited to certain healthcare providers by your Medicare Advantage Plan. Each insurance company is allowed to negotiate contracts with whatever healthcare provider they choose. It is often determined by costs and reimbursement rates, truly nothing to do with the patient. In recent years we have seen many small healthcare providers join together to become much larger offices. This allows for economies, with technology being one of the primary expenses. The more cost effective the healthcare provider is, the better contract they can negotiate with the insurance company.

Good luck with reviewing your options and determining what plan works for you. At the end of the day, remember you are in charge of your own health, responsible for how you take care of your body, and need to determine what works best for you.

Bonus Tip: Ask yourself these questions before choosing a plan.

  • Do I want to be on a Medicare Advantage Plan and/or pay for a supplemental policy?
  • Are my physicians, hospital, rehabilitation center, etc. contracted to take my Medicare Plan?
  • Will my physician, hospital stay, rehab visit, etc be 100% covered by my Medicare Plan?

Need help navigating this complex system? Please call 727-447-5845 to speak with one of our Aging Wisely experts. They can assist you with determining your Medicare options through the Medicare website, help you understand what you need to consider when making your selection, and helping you look ahead to plan for your future.

You might also want to check out our Medicare Fact Sheet 2017, which explains the parts of Medicare and their associated costs for 2017 as well as key dates and FAQs.

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