Cost, Coverage, and Care Quality: Medicare Considerations You Can’t Ignore
When it comes time to make your Medicare selection, you have many things to consider. The three biggest ones are cost, coverage, and quality of care. Whether you’ve recently turned 65 or just aren’t happy with your current plan, looking deeper into these areas will help you make a better choice. Here’s what to factor into your decision.
Cost
Medicare is like most other insurance products in that it involves premiums, deductibles, and copays. With Original Medicare, there is no out-of-pocket limit, and some benefits are capped once you reach a certain dollar value. A supplemental plan (Medigap or Medicare Advantage) can help you set a limit so that you aren’t essentially writing a blank check if you receive treatment for a serious condition, such as a heart attack or liver failure.
With Medicare Advantage plans, the bulk of your cost is in the premium, which may be slightly higher than that of Original Medicare. However, Original Medicare can leave you on the hook for approximately 20 percent of your total medical charges, according to the New York Daily News.
Coverage
Original Medicare can help you cover the cost of basic healthcare. Things like hospital stays and doctor visits are covered under either Parts A or B. If you need dental, vision, or hearing services, you’ll have to upgrade to a Medicare Advantage plan. Original Medicare does not provide prescription drug coverage unless you enroll in Part D, which is a prescription drug plan. Most Advantage plans include prescription drugs and durable medical devices.
You may have more provider choices with Original Medicare, but an Advantage plan, which is either a PPO or HMO, is typically more flexible. Humana explains that a PPO, or Preferred Provider Organization, is the most beneficial when you use in-network providers, which have signed an agreement with the insurance company on cost.
Quality of Care
When you have Original Medicare, you are free to choose any provider that accepts Medicare. These may be limited, however, since the government requires providers to accept what it’s willing to pay for each individual service. A Medicare Advantage plan works on a network platform, so you may be restricted to providers within that network, or you’ll have to pay an out-of-pocket coverage premium. Because care quality can vary from physician to physician, you will need to determine which form of Medicare your preferred providers accept.
If you aren’t satisfied with the provider and wish to look for a new doctor, you may need to change your Medicare plan. Short of interviewing every health care provider in your area, spend some time on HealthGrades.com, which is a website that allows patients to review their doctors. While your experience and relationship with your medical team are unique, these reviews can help you determine your physician’s bedside manner and overall level of competence.
If you’re still unsure about the type of plan you need, talk to an insurance agent. A licensed insurance agent cannot only save you time and money, but he or she can also serve as a translator to help you understand often confusing legal, medical, and insurance terminology. Shopping for a Medicare Advantage plan can be confusing, but an agent can demystify the information and help you make a more informed decision.
The good news is that once you do make a decision, you are not stuck with your insurance plan. Medicare recently approved a secondary enrollment period for Medicare Advantage subscribers. Talk to your insurance agent or Medicare representative about what’s available and if you’re eligible to make changes to your coverage.
Medicare can seem intimidating, but you have numerous resources available to you. With a little time, research, and help, you can find the coverage that’s best for you.
Image via Pixabay
