The Three C’s – Cost, Coverage, Choice – the Right Medicare Plan for You

Making the right Medicare Plan Choice

The Three C's of Medicare Insurance Coverage

Although the term “Medicare” is often used to refer to the health care program for those who are age 65 and over, what many people may not realize is that there are actually several different ways in which you can receive your Medicare benefits.

For example, the Original Medicare program consists of Medicare Part A and Part B, where Part A covers hospitalization costs, and Part B provides coverage for doctors’ visits, as well as required medical equipment and supplies.  (Related: Should I Stick With Original Medicare?) In order to receive prescription medication coverage, you’ll need to buy a stand-alone Medicare Part D plan.

Alternatively, there is Medicare Part C. This program is often referred to as Medicare Advantage. With a Medicare Advantage plan, you will receive all of the benefits that you would get with Medicare Parts A and B. However, many Medicare Advantage plans will also include additional coverages, such as wellness benefits, dental, and / or vision. A number of Medicare Advantage plans also include Medicare Part D prescription drug benefits.  Click here to see a blog entry we did a while back that outlines Medicare Advantage plans.

So, with the variety of options for receiving Medicare benefits, what are some of the top items to consider before you make a commitment to one of these plans?

Important Factors to Keep in Mind When Considering Which Medicare Plan is Best for You

Just as you would when choosing any other type of insurance plan, you will ideally want to keep some key criteria in mind when choosing how you will obtain your Medicare benefits. These items include the following:

Cost

Even though a health care insurance plan should not be chosen based on cost alone, your out-of-pocket expenses can make a big difference. With that in mind, you could run into costs in a number of areas, including:

  • Monthly Premiums
  • Copayments
  • Coinsurance
  • Deductibles
  • Annual limit on out-of-pocket expenses (also known as a MOOP)

In this case, both Original Medicare and Medicare Advantage could come with premium payments, as well as copayment, deductible, and / or coinsurance charges. In addition to that, while Medicare Advantage plans will typically state an annual limit on your out-of-pocket costs (meaning that once you have reached a certain dollar amount limit, you will pay nothing for your covered services for the remainder of that calendar year), Medicare Parts A and B have no limit on how much you will pay. You can, however, consider purchasing a Medicare Supplement insurance plan to help with some or all of these charges.

In some cases, you may see advertisements that state some Medicare Advantage plans have $0 premium. But be careful here, though, and make sure that you read all of the “fine print” before moving forward with such a plan. That’s because, while there may be no up-front premium for the Medicare Part C coverage, the insurance provider may make up for that by charging higher out-of-pocket costs at the time care is received.

Coverage

Certainly, another key factor when considering the right Medicare plan for you is the actual coverage itself. Here, both Original Medicare and Medicare Advantage must cover medical services and supplies in hospitals, doctors’ offices, and other health care settings.

Medicare Advantage plans, however, may provide added benefits, like vision, dental, and / or wellness services. These plans may also include prescription drug benefits, whereas enrollees in Original Medicare would have to purchase a separate Medicare Part D drug plan.
Also, where you can and can’t receive coverage can be an important factor to consider – especially if you spend time traveling outside of the United States. In this case, Medicare Advantage plans typically will not cover the care that you receive when you are outside of the country.

Likewise, Original Medicare will also not usually provide care outside of the U.S. However, if you purchase a Medicare Supplement insurance policy, these plans may provide some care, even if you are outside of U.S. borders.
It is also important to note that, if you are still covered by an employer-sponsored health insurance plan (or other health insurance coverage) when you enroll in Medicare, be sure to check and see how the two plans may (or may not) work together, as well as which plan will be the “primary” payor and which will be the secondary.

Choice of Medical Provider(s)

Being able to choose where and from whom you receive your health care services is also an important criteria in determining the health insurance option that is right for you. In this case, many of the Medicare Advantage plans will require you to see doctors and other health care providers that are listed in a network.

In addition, depending on how the plan is set up, you may also have to get a referral from your primary care physician in order to see a specialist. On the other hand, if you are enrolled in Original Medicare, you are allowed to go to any doctor, hospital, or health care provider of your choosing that accepts Medicare.

With that in mind, the quality of the care you receive should also be near or at the top of your list when choosing a health care insurance plan. The good news is that both Original Medicare and Medicare Advantage offer information that can help you to better determine the quality of the care that is offered by a provider.

For instance, you can get a “snapshot” of the quality of the health care providers – as well as health care facilities – by visiting Medicare.gov. Likewise, the Medicare Plan Finder features a star rating system for Medicare plans, but the site can be very confusing and not give all the information you need.

How to Know Which Medicare Program is Right for You

This is where a good insurance agent can help you.  If you are still unsure of which Medicare plan is right for you, sit down with an agent and go over your options.  They’re not allowed to use high-pressure sales tactics and could very well go over plan options with you that are custom-tailored to your specific area.

Sources:

Medicare and You 2018. https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf