With Medicare, a family and their loved ones should read these four steps to help you choose a Medicare plan that is best for them.
1. Find the Medicare Plans in Your Area
- Not all the Medicare plans are in all parts of the country, but almost all people on Medicare will have a choice. Start by finding out which health plan choices besides the Original Medicare Plan are available in your area. If you do not have any other Medicare plan available to you, you will be in the Original Medicare Plan.
2. Think About What’s Important To You
Each person with Medicare has unique needs and concerns when it comes to health care. Some people are most concerned about keeping costs down. Others want the freedom to go to any doctor they choose, Here are some key differences among the Medicare plans.
- How much you pay in premiums and out of pocket costs
- How much choice you have to select your own doctors or hospitals
- How can you go directly to a specialist
- How can you get additional benefits, such as prescription drugs
- How far you will need to travel to get to the doctor or hospital
- How often you travel for business or leisure
3. Compare the Costs, Benefits, Rules for Doctor Choice and Quality of Each Plan
The amount you pay for Medicare depends on a number of things:
- Which Medicare plan you choose
- How often you go to the doctor or hospital
- If you have other insurance
- If you travel frequently within the United States or leave your hometown for long period of time
The Original Medicare Plan and some Medigap policies will pay your routine health care costs anywhere within the United States. But if you join a Medicare Advantage Plan, such as an HMO or PPO, your coverage may be limited to the area served by the plan. Be sure to check on where the plan’s payment is accepted before you sign up.
- If you travel outside the country:
- Your health care may or may not be covered, depending on the plan you are in. The Original Medicare Plan does not cover care outside the country, except in some emergency situations in Mexico and Canada. Some Medicare Advantage Plans and Medigap policies do cover care outside the United States. Check your plan or policy before you travel.
- If you have high presecription drug costs or if you want prescription drug benefits:
- Medicare Prescription Drug Plans: If you are in Original Medicare or a Medicare Advantage Plan that does not offer prescription drug coverage, you can join any Medicare-approved prescription drug plan serving your area. Drug plans vary in term of the drugs covered and your out-of-pocket costs. You will need to compare plans carefully to find the plan that best meets your needs.
- Medicare Advantage Plans: Medicare Advantage Plans often offer additional benefits, such as prescription drugs. Keep in mind that these benefits can change each year and might only offer limited benefits. Carefully check into the prescription drug benefits of the plans you’re considering.
- Prescription Drug Assistance Programs: Prescription Drug Assistance Programs offer free or discounted prescription drugs.
- All Medicare plans offer the same basic set of benefits. However, some Medicare Advantage Plans may have additional benefits, such as eye care or prescription drugs
- Rules For Doctor Choice: .
- In the Original Medicare Plan, you can go to any doctor or hospital in the country that accepts Medicare – most doctors and hospitals do. In a Medicare HMO, you usually can only go to the doctors and hospitals in that plan’s network. Some HMO’s offer a Point of Service Option, which allow you to go to doctors and hospitals outside the plan network, but you may pay more.
- In a medicare PPO, you can go to doctors and hospitals outside the plans network, but you usually have to pay more.
- In a medicare PFFS Plan, you can choose any doctor or hospital that accepts the plans payment.
- Another common concern about doctor choice:
- Being able to go directly to a specialist. In the Original Medicare Plan, PFFS Plans and most PPO’s, you can go directly to a specialist. In Medicare HMO’s, you usually are able to see a specialist only if your primary-care doctor first approves your visit. Find out the rules about getting care for each plan you are considering and be sure to ask for a list of the doctors and hospitals in each plans network.
- Quality information can tell you:
- How well the plan does in keeping its members healthy
- How well the plan treats those who are sick
- How well doctors in the plan communicate with their patients
- How easy it is to get a referral to a specialist if one is needed
4. Choose the Plan That’s Best for You
After you gather the information about your plan choices and have thought about what’s important to you, take your time sorting through the information you have. Ask more questions and talk to people and groups that you trust. Help is available to you if you need it.