Medicare Plans

The best Medicare plans aren’t always the most comprehensive, nor are they always the least expensive. The best Medicare plans are the ones that provide health insurance beneficiaries the benefits and flexibility they need at rates they can afford.

When it’s time to select your Medicare coverage, be prepared to invest some time researching the best Medicare plans. To find the best plan, you need to compare policies, rates, and insurance providers carefully.

When choosing Medicare coverage, you have two options:

• Original Medicare insurance (Medicare Part A hospital and Medicare Part B medical)
• Medicare Advantage (Medicare Part C). Some plans have no monthly premium.

Here’s what you need to know to choose the strategy that’s best for you.

Medicare Advantage Plans

Medicare Advantage plans tend to be the best Medicare plans that require a provider network. Beneficiaries typically can choose from three types of Medicare Advantage plans:

• PPOs (Preferred Provider Organizations)
• HMOs (Health Maintenance Organizations)
• PFFS (Private fee-for-service)
• Most Advantage plans use certain Open Enrollment periods.

The three plans differ in how they handle certain situations:

• Referrals: not required in PPOs and PFFS, required by HMOs
• Prescription drugs: may or may not be included in all three
• Primary care physician: required by HMOs, not required by PPOs and PFFS

You typically have three times you can enroll in a Medicare Advantage plan:

• Initial Coverage Election Period (ICEP)
• Annual Election Period (AEP)
• Special Election Period (SEP)

All Medicare Advantage policies offer the same benefits as Medicare Part A and Part B. Some may include vision or dental. Here’s additional information on the best Medicare Plans with a network:

• You have to be enrolled in Medicare Part A and Part B to qualify.
• You must live in the service area of the MA plan.
• Except in emergencies, care provided outside of the network is either not covered or covered at a reduced rate.

Again, to find the best Medicare plans, it’s essential that you compare benefits, premiums, and the amount you’re required to pay for deductibles, coinsurance, copayments and Medicare costs.

Medicare Supplement Plans

The best Medicare plans without a network are Medicare Supplement plans, also called a Medigap policy. Medigap policies help cover expenses left after Original Medicare insurance pays its portion. You must buy these Supplement policies from a private Medicare Supplement insurance company. Medicare Supplement insurance policies offer flexibility when seeking care:

• There are no provider networks. You can visit any doctor or use any hospital as long as they’re signed up with Original Medicare.
• There’s no need for referrals.
• Your insurance is good anywhere in the United States.

Other things you need to know about a Medigap policy:

• To be eligible, you must be enrolled in Medicare Part A and Medicare Part B.
• The best time to sign up is during your Medigap policy Open Enrollment Period because you have guaranteed acceptance.
• If you don’t enroll during your OEP, coverage might be denied.
• Medigap health plans do not cover prescription drugs.
• Premiums vary based on benefits, insurer, and amounts you pay for copayments, deductibles, and coinsurance and out-of-pocket costs, so be sure and compare the policies to find which one offers the best plan options for your needs.

Best Medicare Plans with Prescription Drug Plan

Because Original Medicare and a Medigap plan do not cover drugs (Medicare Part D), the best Medicare plans offering drug coverage are through Medicare Advantage. Medicare Advantage policies that cover prescriptions are sometimes called MAPDs (Medicare Advantage Prescription Drug).

Each MAPD has a list of drugs that it covers. This list is called a formulary, and it might differ between Medicare Advantage policies. If an insurer changes the formulary, it must notify you. To compare the best Medicare drug plan benefits between policies, here are a few things to look for:

• Are the medicines you take listed on the formulary?
• Does the formulary include generic and brand name drugs?
• What are the medication deductibles, copayments, and coinsurance for each plan?
• Do any drugs require prior authorization?
• Are there pharmacy restrictions?

Although most Medicare Advantage policies include Part D, a few fee-for-service policies do not. If your Medicare Advantage plan doesn’t cover prescriptions, you can buy a separate Part D policy. If your MA policy covers drugs, and you enroll in a separate Part D policy, Medicare Advantage can remove you from its plan and return you to Original Medicare.

Best Medicare Plans on Fixed Income

Combining hospital, medical, and prescription drug benefits into one Medicare Advantage policy might be cheaper than three separate policies for Original Medicare, Medigap, and Part D. There are also several programs that can help seniors on a limited income and with limited assets pay their healthcare costs and narrows down a plan:

• Dual eligibility with Medicaid
• Medicare Savings Program: helps with costs ranging from premiums to deductibles and copays
• Medicare Extra Help Program: helps cover prescription medications
• PACE (Program of All-inclusive Care for the Elderly): available in some states through Medicaid

Helpful Medicare Resources

Medicare Savings Programs

Medicare.gov

State Insurance Departments