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5 questions to help you choose the right Medicare plan


You’ve accomplished several life milestones, including birthdays, weddings, promotions, and possibly even grandkids. Another one of those times to treasure is turning 65. You have gained wisdom, but you may also have gained the freedom to travel, follow your interests, and spend more time with your loved ones. And all of those are reasons to rejoice. You can also enroll in a Medicare plan at this time.

But where do you even begin? Consider this for a moment: How might my Medicare plan support me in leading the life I desire?

That entails taking into account both your individual goals and your health requirements, such as the prescription medications you take and how frequently you visit the doctor. Do you have travel plans? More family time should be spent. take up a fresh endeavor?

Spend some time thinking about how you want to use your time. What are your objectives? And what about your requirements? When deciding on Medicare, everything is important. Of course, your financial situation also matters.

As you move forward with your trip, asking yourself the proper questions can help you make sure you’re on the correct track. You want to be sure to receive the coverage that suits your needs because coverage possibilities differ by plan.

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1.      What do extra benefits, such as vision, dental and hearing coverage, have to do with reaching my health goals?

Do you like to read the newest book by your favorite author at a rapid pace? Or are you having a dream about the first coos you heard from your granddaughter? Nothing should stand in the way of you experiencing each moment to the utmost. And it entails safeguarding your eyesight, preserving good oral hygiene, and monitoring any changes in your hearing. As you sort through your coverage alternatives, keep in mind both your immediate and long-term needs:

Comprehensive vision, dental, and hearing coverage is not included in Original Medicare (Parts A and B). You will be required to pay in full for such services with a few exceptions. You must purchase a separate plan to cover vision, dental, and hearing services if you have Original Medicare.

Many Medicare Advantage plans include hearing, dental, and vision expenses. They are provided by private insurance. You must determine whether you only require routine care (like cleanings and screenings) or coverage for procedures and supplies because coverage and costs vary (like dental implants and contact lenses). Find out more about the variations between Medicare Advantage and Original Medicare here.

Additional benefits including dental, hearing, and vision coverage may be included in some Medicare Supplement plans. Discover more here about how to extend your Original Medicare coverage.

2.      Do I want the flexibility to see any doctor?

Finding the best doctor is a crucial step in your medical journey. In light of this, you should be aware that not all Medicare Advantage plans allow you to see primary care physicians and specialists outside of their network. Others charge more, but they let you pick any doctor. You must decide if the advantages you would receive from an in-network provider outweigh the importance of continuing to see your present providers, even if they are not in the network. The network frequently enables greater care coordination between providers, which can help you manage your health care better.

In contrast, Original Medicare is a federal program that allows you to see any doctor as long as they accept Medicare. For instance, you can still see doctors in both New Jersey and Florida if you spend six months of the year there and the other six in Florida. It might be more difficult for those doctors to share information about your care since they may not all be a part of the same network, forcing you to do more of the legwork. Additionally, Original Medicare normally has no annual cap on the amount you can spend on approved medical expenses. Find out more about how a Medicare Supplement can assist you with supplementary costs.

What you need to know is as follows:

You must remain in the network and get referrals to see specialists if you enroll in a Medicare Advantage HMO plan. For emergency care or urgent care beyond the local region, there are some exceptions. The copays and monthly charges for some plans might be lower.

You may pay higher monthly premiums for Medicare Advantage PPO plans, but you will have more freedom to visit providers who are outside of the network without a referral.

Make sure your plan can accompany you if you intend to go abroad while receiving Medicare benefits. Original Medicare often does not provide coverage for costs incurred outside of the United States and its territories. However, there are a few outliers. For instance, Medicare might cover some of your medical expenses if you become ill in the United States and a foreign hospital is more convenient than one here.

Check your plan’s network if you frequently travel inside the US or intend to spend time away from your home address. Make sure the area you’ll be visiting has access to medical professionals who take part in your Medicare Advantage plan.

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3.      Do I plan to travel outside the United States?

It is best to add to your coverage if you want guaranteed coverage abroad.

If you receive care within the first 60 days of your trip, some Medicare Supplement plans might pay for medical services or supplies that you obtain outside the United States.

Emergency medical care received outside of the country may be covered by Medicare Advantage plans. Check with your plan representative before you leave the country because not all plans are created equal.

4.      Do I need prescription drug coverage if I’m not taking much medication?

Even though you might be feeling good right now, it might be necessary to occasionally take medication if you want to keep feeling good. In general, a prescription that your doctor writes for you won’t be covered by Original Medicare. Consequently, a separate prescription drug plan will need to be included. If you’d prefer to have just one plan, you can buy a Medicare Advantage plan that covers prescription drugs. Before choosing one of these plans, consider the following:

What drugs are covered by my insurance plan? How much will they cost? Every Medicare prescription drug plan has a unique formulary, or list of approved drugs, that groups different prescriptions according to to cost.

What happens if my insurance refuses to cover my prescription costs? The formulary might not always have your medication on it. Your doctor might ask the insurance provider to make an exception if it isn’t already on the list. If the plan allows the exception, you will frequently be charged the highest pricing tier.

Are the pharmacies that I want to use open? To fill your prescriptions, you can make use of the network of pharmacies that all Part D plans provide. Utilizing one of the pharmacies on certain plans’ preferred provider lists can help you save even more money.

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5.      Do I want to juggle multiple Medicare plans?

You might be changing a lot in your life at this busy time. Maybe you want to make things simpler. You have a choice if you choose to have all of your benefits in one location rather than adding a Medicare Supplement and prescription medication plan to your Original Medicare coverage.

Your hospital coverage (Part A) and medical coverage are combined under Medicare Advantage plans provided by private insurers (Part B). The majority of insurance offer coordination of care through their networks and cover prescription drugs. However, you should think about whether you should select a structured Medicare Advantage plan.

like an HMO, where you may need referrals and can only see doctors in a specific network

Like a PPO, where you’ll have more freedom to visit doctors who aren’t in the network but will charge more

After giving these issues some thought, you are better equipped to choose a plan that will support your healthcare requirements. After that, you can resume doing the activities that bring you joy.


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