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How do I Choose Between Medicare Plans?

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  • Written By: Tricia Ellis-Christensen
  • Edited By: O. Wallace
  • Last Modified Date: 30 August 2016
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It can be confusing and difficult to try to choose Medicare plans. There have been some changes in recent years in the way Medicare is offered. Some people don’t choose a plan and simply accept their Medicare Part A and Part B, while others take these two and add on a Medicare Part D Plan, also called prescription drug coverage. Alternately, some people opt to buy a Medigap plan, which might cover prescription drugs, and may help meet some of the costs of coinsurance payments and deductibles still due under Part A and Part B. The other option is to enroll in Medicare Part C or Medicare Advantage Plans, which may be health maintenance organizations (HMOs), preferred provider organizations (PPOs) or private fee for service (PFFS) plans.

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When discussing Part C, many people have found this a good option as compared to simply taking Medicare in its normal form. Depending on where people live they should have access to a number of plans that they typically pay for on top of paying Medicare Part B payments, which can slightly to greatly raise total health costs each month. Usually the least expensive of these plans are HMOs, which limit the number of doctors people can see. Each doctor is a participant in a network, and patients require approval to see a specialist. Only rarely, when there are no specialists available in network, can people go outside of the network. An HMO may nevertheless be a good plan if it has lots of providers, and people will pay copayments that are predefined instead of coinsurance. On top of that, these plans are likely to have low deductibles if any.

PPO Medicare plans are somewhat similar to the HMO, but they do allow people to see specialists on their own referral. The choice may be an advantage here, but there can be inherent financial problems with a PPO. If people go outside of the preferred provider network, they may pay much more in costs, and might have to meet very large deductibles, in the nature of thousands of dollars before the insurance company will reimburse doctors for anything. In recent years, PPOs have not only begun to charge a copayment for services but they also assess coinsurance payments (percentage) for certain services like procedures in a medical office and hospitalization.

Furthermore, many PPO plans now have a limited number of in network providers and this could mean people could quickly be spending lots of money to their deductible amount. Those interested in PPOs should get a provider list and then call specialists on that list to verify they still participate. On top of that, those considering PPOs should determine if they could afford any deductibles that must be met.

The private fee for service Medicare plans usually assess an extra fee over the Part B payment. The company with which a person contracts sets a deductible and then people are free to see any doctor who will take them. This last part is important; doctors have the right to accept or refuse this insurance at any time, and a doctor who takes it once, doesn’t have to accept it in the future, which might conflict with continuity of care. In addition to paying the set copayment, the person being charged will also likely pay 15% over the typical Medicare fee. On the other hand, like PPOs and HMOs, PFFS Medicare plans may cover things that are not traditionally part of Medicare coverage.

Many of these plans offer prescription drug coverage, which is a good thing to look for. People should compare plans, investigate available providers in HMOs and PPOs, and look at deductible charges, while they evaluate specific benefits offered by each plan. They can also compare these plans against Medigap coverage, which may provide additional coverage and mean people pay out less money in things like coinsurance for regular Part A and B services. Should people choose one of the Medicare Plans that doesn’t provide prescription drug coverage, they should look to the different Part D plans that do provide this, and which may help save money on prescription drugs.

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anon296964
Post 1

Could they make it any more complicated and frustrating trying to decide which type of Medicare plan is best for me?

What is needed is a questionnaire for the purpose of identifying each individual's particular health, financial situation and priorities.

It is not reasonable to expect an average person to learn everything that is necessary to make the best choice these days. I have become increasingly frustrated.

The longer I try to gain a comprehensive overview in order to make the right choice, the more I see that a lay person like myself, really needs a well-informed and neutral professional insurance counselor to guide me. Does such a person exist, or do the vast majority of seniors, even those

tenacious types who try to persist until they fully understand this mess, soon give up and just pick one to be done with the headache? I am sure they do.

It's sort of like how most people vote for their elected officials, except that the choosing of a medical insurance plan option for your "last lap" could have far more important personal consequences.

People need a more simplified guide to help them choose the type of plan that best suits their personal health situation and financial ability.

Only when I am confident that I understand my choices will I able to choose wisely. Surely what I am suggesting is not unreasonable.

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