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How Do I Choose the Right Medicare Plan?

Medicare Coverage Options

Choosing a Medicare plan can be a confusing and difficult process. At Medicare Solutions, we will facilitate the process for you and help you select the Medicare plan that best suits your needs. In addition to Original Medicare, there are a variety of different plans that can give you the health coverage you need. If you decide to enroll in the traditional Medicare plan, you can add a supplementary Part D prescription medication plan or supplementary Medigap insurance. If you are eligible for Medicare Advantage programs, you can enroll in an HMO, PPO, private-fee-for-service (PFFS), or medical savings account (MSA) plan, depending on its regional availability and eligibility requirements. If you are dissatisfied with your plan, you have the option to enroll in a different plan or original Medicare during the open enrollment period.

When choosing your Medicare plan, there are several variables that you need to keep in mind. Many Medicare plans are located regionally and are not available everywhere in the United States. To find out what plans are available in your area, navigate around the Medicare Solutions site or call (800) 328-7305.

You must also determine what you need in a Medicare plan. Some Advantage plans can offer you additional benefits, available at an additional charge. Many Advantage plans can lower your health care costs, depending on the plan you select. Some Advantage plans, like HMOs or PPOs, limit the doctors and providers you can use to a local network: if you use providers outside of the network, you may face an extra charge. On other plans, you are required to get a referral from your primary care physician in order to see a specialist. Travel arrangements are another important factor in selecting a plan. If you chose an Advantage plan with a network and frequently travel outside the network, that plan might not suit your needs.

Cost is a major factor that you should consider when enrolling in Medicare plans. If you enroll in the traditional Medicare program, you may opt to pay for a supplemental Medigap policy. Advantage PPOs and HMOs often provide the same services as Medigap policies. Some HMOs and PPOs will charge you if you decide to use an out-of-network provider. Some Medicare Advantage plans already include prescription medication coverage, so it is not necessary to enroll in a complementary Part D prescription drug plan. Extra benefits may be available at additional costs, so it is necessary to understand the costs associated with your plan.

Another important issue to contemplate before you enroll in a Medicare plan is the benefits included. CMS requires all Advantage plans to provide you with the same general coverage that you would receive under Medicare Part A and Part B. Some Advantage plans include vision, dental, medication, and hearing coverage at a possible extra cost. However, some Advantage plans have restrictions on the doctors, hospitals, and specialists that you can use. HMO plans require you to use network providers, and you may have to pay extra to use out-of-network providers. Generally, HMO plans will allow you to see a specialist only with the referral of your primary care physician. In PPO plans, you can access physicians outside the network, but it may come at an additional charge. Most PPO plans permit you to see a specialist without a primary care referral. If you enroll in a PFFS plan, you can visit any provider you want as long as they accept the plan's terms of payment. Referrals are not necessary for specialist appointments.