Do you ever wonder what Medicare plan you should pick?
This is one of the most critical decisions you will make in your 60s and 70s, so I’m always glad when people ask me. I’m glad they ask this question because I want to ensure they make the right decision.
I’ve found that the #1 reason people regret their Medicare decision is because they picked the wrong program.
Getting this decision wrong can cost you a significant amount of money and not allow you to see the doctors you want.
But this is an easy mistake to avoid and I’ll show you how.
To answer this I always start by explaining there are 2 Medicare programs: Original Medicare and Medicare Advantage. You need to pick the right program when you first join because of insurability rules.
Let me share with you the top two of the ten questions we ask clients to determine which program is best for them
1. What doctors do you want to see?
2. How much do you want to pay?
What doctors do you want to see?
There are significant differences between the two programs when it comes which doctors you can see.
Original Medicare is accepted by any doctor who accepts Medicare assignments. While most Medicare Advantage plans operate like HMOs or PPOs so usually only doctors in their network will accept the Advantage insurance.
Since most people want to be able to continue seeing their current doctors, I highly recommend you talk to your doctor and understand which types of Medicare they accept.
But please keep this in mind. Original Medicare is very stable when it comes to the doctors it covers, while Medicare Advantage is less stable. What this means is that from time-to-time Medicare Advantage plans will no longer cover certain doctors, or doctors will decide to no longer accept Medicare Advantage insurance.
This instability can create challenges for clients if their doctor is dropped. We especially see this issue in rural communities where Medicare Advantage plans decide to drop coverage of an entire county.
On the other hand, we have seen that because of how Original Medicare is set up, most doctors accept Original Medicare, and there is very little changes to which doctors accept the plan.
How much do you want to pay?
The money part of Medicare is a big factor into what program is best for you. There are three main items you should look at to understand what it will cost you
1. Premiums:
If you choose Original Medicare, I highly recommend you get a Medicare Supplement plan. You can read more here but Supplement insurance will cover the 20% of your Medicare expense you are responsible for.
Supplement insurance plans range from $30-$300/month, with most of our clients paying an average of $90/month in supplement plan premiums
If you choose Medicare Advantage, many plans advertise a $0 premium
2. Co-Payments
If you choose Original Medicare, Medicare pays 80% of your medical expenses and you are responsible for the remaining 20%. But when you have a supplement plan, the supplement plan pays for the 20%
If you choose Medicare Advantage, the plans have copays for most services. So when you visit your primary care provider there will likely have a copay of $20-50 per visit depending on the plan you pick
3. Out-of-Pockets Maximums
If you choose Original Medicare, your out-of-pocket maximum depending on the supplement plan you pick (if you don’t have a supplement plan you don’t have a maximum out-of-pocket). Most of the plans our clients are in have an out-of-pocket from $183 to approximately $2,000.
If you choose Medicare Advantage your out-of-pocket maximum will be $6,700
For these two key reasons above we see that approximately ninety percent of our clients pick Original Medicare.
These are some of the key items to picking the right plan but please do the research to ensure you are picking the right program for the beginning
If you are turning 65 or enrolling in Medicare in the next 6 months, I invite you to join our free online Medicare workshop “How to Make the Best Medicare Decision Without Wasting Time on Research or Paperwork”.
In this workshop I will go through more details so you make the right Medicare decision
Click here to join the workshop
