What Makes a Medicare Insurance Plan Right for Me?

Updated: Apr 8

When making decisions about health insurance, it’s important to think about all the factors that will affect the way you use health care. For seniors on Medicare insurance, the best time to make decisions about which Medicare insurance plan is right for them is during the Annual Enrollment Period (AEP) between October 15 and December 7. Fortunately, you still have time now to review your existing Medicare Advantage Plan to make sure you are getting all the benefits you deserve.

In this article we will take a look at steps to help you choose the right Medicare plan for your needs. Don’t forget that our Medicare agents are standing by, ready to help with any questions you have about Medicare insurance. It is our pleasure to help kupuna find the right plan for their needs and budget.


What Makes a Medicare Plan Right for Me?


Step 1: Compare your Medicare insurance options


The four main Medicare insurance options are:


1. Original Medicare

2. Original Medicare with supplemental insurance

3. Medicare Advantage Plan

4. Medicare Medical Savings Account (MSA) combined with a high-deductible insurance plan


All Medicare Plans include Medicare Part A and Medicare Part B. While this is all that is included in Original Medicare, Medicare Advantage Plans and supplemental insurance options bring a lot more coverage to the table. It is best to speak with a Medicare agent to review your choices.


Step 2: Network coverage


Different types of Medicare plans come with different coverage rules. Some plans allow you to seek medical services from any health care provider who accepts Medicare assignment while others require that you use “in-network” doctors and health care facilities in order to receive the best coverage.


If you choose a plan that is setup for in-network care, it’s very important to make sure that all the doctors and health facilities that you want to continue a relationship with have in-network status. Eliminate plans that exclude your doctor or any local doctors in the provider network.


The following types of Medicare Advantage Plans generally require their members to choose a primary care doctor and/or receive care and services from providers in the plan's network in order for the member to pay the lowest cost:

  • Health Maintenance Organization (HMO) Plans

  • Preferred Provider Organization (PPO) Plans

  • Special Needs Plans (SNPs)

  • Medicare Medical Savings Account (MSA) Plan

Private Fee-for-Service (PFFS) Plans and Original Medicare, on the other hand, allow their members to seek care with any Medicare-approved doctor, other health care provider, or hospital that accepts the plan's payment terms and agrees to provide healthcare services.


Step 4: Compare out-of-pocket costs


Every Medicare insurance plan comes with at least some out-of-pocket costs like co-insurance, deductibles and co-pays. This is why you cannot base your budget on the monthly premium alone. In fact, generally speaking, the lower the premium, the higher the out-of-pocket costs. You will need to make a decision about whether you want more health coverage and higher premiums, or lower premiums and higher-out-of-pocket costs.


Seniors who require frequent medical care, take expensive brand-name medications or who have a chronic condition such as diabetes may benefit the most from a plan with a higher monthly premium but lower out-of-pocket costs. On the other hand, seniors who rarely need to see a doctor or who cannot afford a plan with high monthly premiums may prefer a plan with low monthly premiums.


It’s also important to know that there is no out-of-pocket annual maximum for Original Medicare but there is for Medicare Advantage Plans.


Step 5: Compare benefits


Every Medicare plan must cover Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) but there is often a huge difference in the other services covered. Make sure to choose a plan that will pay for any regular and necessary care you require such as specialists and prescription drugs.


Some questions to consider when comparing benefits:

  • Do I stay in state or travel out-of-state often?

  • Do I have specific prescription drug needs?

  • Do I have a chronic condition that requires specialist care?

  • Do I require mental health services?

  • Do I want a plan that includes coverage for hearing aids, dental and vision care?


Contact a PBC Agent for Help


Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.


At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.