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10 Questions to Ask Before Enrolling in a Medicare Plan

Medicare open enrollment begins tomorrow, and as many of us know, that means a dizzying array of choices for seniors, especially when it comes to selecting a good Medicare Advantage program. (This program is also known as a “Medicare private health plan” and is just Medicare offered through a private insurance company.) It might not be anyone’s idea of fun to pick apart these plans, but it can save you a ton of money, experts say.

“While reviewing your options, you may be attracted to low-cost drug plans or Medicare Advantage plans, but it is very important to read the fine print,” writes Joe Baker, president of the Medicare Rights Center. “Depending on your health status and the plan’s rules and restrictions, you may discover that the low-cost plan will actually cost you more than a plan with a higher premium.”

To help seniors sort out which Medicare Advantage plans might save them money while also giving them the best benefits, the Medicare Rights Center has developed a list of questions seniors should ask before enrolling in a plan.  Here are some of the key items from their list:

  1. Will I be able to use my doctors? Are they in the plan’s network and are they taking new patients who have this plan?
  2. Which specialists, hospitals, home health agencies and skilled nursing facilities are in the plan’s network?
  3. How much is my monthly premium?
  4. How much will it cost to see my primary care physician? A specialist?
  5. Are my prescription drugs on the plan’s formulary (list of covered drugs)?
  6. Does the plan require that I get “prior authorization” before my prescription will be covered, or impose other restrictions (like limiting the quantity or requiring that I try a cheaper medication before it will cover a more expensive one)?
  7. How much will I have to pay out of pocket before coverage starts (what is the deductible)?
  8. How much will I pay for brand-name drugs? How much for generic drugs?
  9. What service area does the plan cover?
  10. What kind of coverage do I get if I travel outside of the service area?

For a complete list of questions and additional guidelines of choosing a Medicare Advantage plan, click here.


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    • The deadline for next year only pertains to Medicare Advantage and Part D Prescription Plans.  If you have a Medicare Supplement, you don’t have to do anything if you are happy with it. 

      The most overlooked fact relating to Medicare Supplements is the fact that all of the plans are standardized by the Center for Medicare and Medicade Services. What this means for the consumer is that they are comparing apples with apples.  For example, all Plan Fs regardless of the insurance carrier cover the same gaps in original Medicare.  The only difference between the various insurance carriers Plan F’s is the price, customer service, and stability of premiums.  I have seen the same plan offered by competing carriers vary in price by as much as $75 per month.  On the other hand it is hard to find two Medicare Advantage plans, or Part D Prescription plans that are alike.

      A very useful website that can help you with your decision is http://www.MedicareAnswersUSA.com . At this site you can research premiums for various plans from major carriers.  There is also an online program that will help you decide which plan is best for you.

About Encore

  • Encore examines the changing nature of retirement, from new rules and guidelines for financial security to the shifting identities and priorities of today’s retirees. The blog also explores news that affects retirement, from the Wall Street Journal Digital Network and around the web. Lead bloggers are reporter Catey Hill and senior editor Jeremy Olshan. Other contributors include The Wall Street Journal’s retirement columnists Glenn Ruffenach and Anne Tergesen; the Director for the Center for Retirement Research at Boston College, Alicia Munnell; and the Director of Research for Pinnacle Advisory Group, Michael Kitces, CFP.