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What to Know When Choosing a Medicare Plan

October 20, 2021 – As we pointed out last week we are now in the Medicare Open Enrollment Period, which ends December 7. This is the time to re-evaluate your plan and change it if your circumstances have evolved, or you are unhappy with the plan you have. To help out with that process, we going to give a brief summary of some key points from an excellent article that came out last week in the Wall Street Journal, “8 Things to Know When Choosing a Medicare Plan“.

Neal Templin wrote this helpful article and we recommend reading it for more detail (we hope the link above will allow you to access it without being a subscriber). Templin says that when it comes to Medicare you have three choices: Regular Medicare (Parts A, B, and D), Medicare plus a private supplemental plan (some people call it Medigap or traditional Medicare), and Medicare Advantage (Part C). The decision for which one to pick is complicated and depends on your own personal situation.

Supplemental (Medigap) plans are generally better for affluent and older people. You will pay higher monthly premiums, but you usually don’t have to worry about going out of network or running up against spending caps. As you age, chances are you are going to have serious health issues, so a supplemental plan is probably better.

Medicare Advantage plans might be better for healthy people. If you are healthy and don’t anticipate many medical expenses, Medicare Advantage might be the best option. In many cases you can get a zero premium plan instead of one that might cost $200 or even much more per month, and get many extra coverages like Part D (prescription drugs) or vision care as well. Not paying a premium can make up for a lot of deductibles. Recently Medicare Advantage plans began to outsell supplemental plans for these reasons.

Going with traditional Medicare alone (Part A and B) is risky. Part A covers hospital expenses and Part B the doctor’s part. But if you are in an accident or have serious health issues you could have a big financial exposure, particularly if you end up in a hospital or long term nursing facility for more than 20 days. You also need Part D to cover your prescription drug cost exposure.

Switching from Medicare Advantage to supplemental can be tricky. In some states insurers have the right to question you or deny coverage. So thinking you will start out with Medicare Advantage and switching to a supplemental plan down the road might not be an option.

Medicare Advantage plans differ. Some are HMO plans, where you must stay in network. PPO plans, which can have higher premiums of up to $10,000 per year, give more flexibility about who you choose for your health provider.

People who travel or snowbird might be better off with a supplemental plan. That is because you could find yourself having to use an out of network provider and not be covered.

Bottom line

Choosing which type of plan is tricky, complicated, and can change over time. So use this Open Enrollment Period to re-evaluate what you have. Talking to a qualified insurance professional is a great idea. It won’t cost you anything, and they have loads of experience to help you make the smart choice for you.

For further reading:

• Medicare Open Enrollment Starts Oct. 15
• What You Need to Know About Medigap Insurance
• What Is Your Medicare IQ
• Original Medicare Vs. Medicare Advantage – Which Is Better for You?

Comments: What type of plan do you have? Are you thinking about switching? Please share your thoughts in the Comments section below.