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Deciding on a Medicare Plan: Experts Weigh In

Deciding on a Medicare plan can seem overly complicated, tough, and, above all, stressful. We sat down with some experts to get the best information on selecting the best Medicare plan for your needs. The following questions and answers were transcribed from our interview posted on YouTube. The Medicare experts we interviewed were LaMonica Thomas and David Ireland.

What are Some Deciding Factors for Medicare Plans?

David Ireland: There are usually 3 main factors to consider when deciding on a Medicare plan; budget, general health, and healthcare networks.

Obviously making sure your budget in retirement or other circumstances fits with a Medicare plan is hugely important. Your general health can also factor into plan choices.

Not all Medicare plans can discriminate based on your health but as far as how healthy you are or aren\’t might be a good indicator of which type of plan you want to choose.

If you like your doctors, making sure a Medicare plan you choose is in network with your current doctor is important. If your doctor is not in network with a chosen Medicare plan, you won’t be able to see them unless you pay cash.

What are the Costs of Selecting a Medicare Plan?

LaMonica Thomas: You have to determine what your needs are because when you\’re turning 65 you\’re going to get all these different advertisements in the mail and online. These ads are going to tell you ‘this plan is great for you’ and ‘this plan is better for you this plan is.’ 

But you have to really have a realistic talk with yourself and say ‘okay, these are my medical needs. I\’ve got to determine what I am looking for in a Medicare plan.’

Maintaining certain relationships with your current doctors may also be affected based on plan details. You may find out when you turn 65 that relationships with networks will not take certain Medicare plans.

You will then have to make the determination of whether or not losing the services of specific doctors or institutions is worth it. If you choose the change it up, you have to get prepared for that transition from a group employer plan (for example) to a Medicare plan. You definitely want to find out if existing doctor relationships will be maintained after switching to Medicare.

Ask your doctor’s office if they accept the plans you are looking at. If they don’t take a plan you like, consider a Medicare supplement. This could play an important factor if you\’re in good health. Maybe you don\’t want to start spending a certain amount each month when a Medicare Advantage plan might be a better fit where you don\’t have to worry about a monthly premium.

These are questions you\’re going to have to ask yourself every year. You always want to do annual reviews with your Medicare plan because plans change–the benefits that they offer change, and/or your PDP can change.

How do I Choose the Best Medicare Plan?

David Ireland: There isn’t a ‘best’ Medicare plan. Plans are totally dependent on the needs of a given patient.

 Keep in mind that a lot of people in general who have to get into the world of Medicare and trying to figure it all out may not even be on medicare themselves. Maybe they have a parent or a loved one that needs a little bit of help with Medicare.

Reviewing current plans is imperative. As needs change an individual Medicare plan may need to change as well. If a friend or family member isn’t available to go over Medicare plan details, you may want to talk to an agent.

An honest agent will tell you if you\’re already in the right place or if there is possibly a better option. Agents will make some recommendations for alternative options where appropriate, if necessary. Plan benefits change every year!

Each year the provider networks and doctors may be bought out by a hospital system that accepts different plans and no longer accepts a plan you may be on. Or your doctors might change the medications that you take, so plan formularies (which is the list of the covered medications and how much uh you\’re responsible to pay when you fill those prescriptions) can also affect plans.

A plan that may have been the ‘best’ in the past may not be the ‘best’ in the present.

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About the Medicare Experts

David Ireland is a marketing director with The Brokerage Inc. He started in the Medicare business 11 years ago as an agent and as an agent manager with a large carrier. He now supports independent agents and agencies.

LaMonica Thomas is a licensed Medicare specialist. She has been in the Medicare business for nine years and is now a medicare broker which means she represents different Medicare insurance carriers in order to help her clients find the best plan for their needs.

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