Method to Choose a Medicare Plan

Methodology to Decide on What Plan

First Level Decisions

• If you have a beloved Primary Care Physician, only consider plans that allow you to continue seeing that person.

• If you have a beloved Hospital System, only consider plans to use their facility.

• If you do not have beloved doctors and hospitals, it is relatively easy to pick the doctors in the plan you would like to see, and their location is convenient.

• If cost is no issue, then Original Medicare with a Medicare Supplement Plan G and a separate Prescription Drug Plan gives one the most freedom of choice and financial protection in any catastrophic health issue.

• If cost is an issue, you should be looking at Medicare Advantage plans as long as a limited physician panel and hospital panel constraints are acceptable.

Second Level Decisions

• Look at the Insurance Company. Are they big and financially strong? Do they have a company service ethic culture? Do they initially come in at a low premium price and then rapidly increase the premiums as one age, or do they practice selling off a book of business to another company for profit? Do they say one thing and do another? What reviews can you find on the Internet?

• Look at the number of providers contracted with them in your geographic area and the hospitals. There is more flexibility if the number of contracted providers is high. It speaks well of the company that high numbers of providers accept the prices the company pays them.

Third Level Decisions

• Take stock of your last 3-5 year average of seeking healthcare services. The number of PCP visits per year; Specialist visits per year; Lab draws per year; Diagnostic imaging tests; Outpatient surgeries; ER; Hospital. Make a list of your prescription drugs. Then plug in those average utilization numbers into each plan you are looking at and then arrive at their total cost, including premium cost. The goal here is to rank plans by their costs, given your usual healthcare needs.

• Next, add an outpatient surgery and one 7 day hospitalization plus your usual average utilization. Rank the costs now.

• Finally, for catastrophic evaluation, add two ER visits and five 10-day hospitalizations. Use the lower Maximum Out of Pocket or sum of all your costs.

• In the catastrophic evaluation, you will most likely find the higher-priced Medicare Supplement and Drug Plan will do best and then the higher premium Medicare Advantage Plan because its co-pays are lower and MOOP is lower than Plans with a low premium.

• In reality, your 3-5 years average annual healthcare utilization is what it will be for the next five years.

• The best protection against catastrophic financial loss from a catastrophic health issue balanced with an expected healthcare utilization will be a high per month premium plan compared to a $0 plan. But if financial reserves are strained, a $0 plan may win out on a 10-year average despite one catastrophic event.

• Adding a third-party Hospital Indemnity plan to a low-cost premium Medicare Advantage Plan ends up being the least expensive option over a 10-year or longer period of time. This combination of coverage gives the greatest protection with a catastrophic healthcare utilization year while assuming most years will be low utilization.

Fourth Level Decisions

• Use an independent insurance agent who wants to keep you as a client over many years. They know the health insurance industry. It is in their best interest to ensure a balance is struck between financial protection, pure premium cost, typical healthcare utilization total costs, customer satisfaction, and good health. But participate in the decision process as outlined above.

• Look at other advantages such as Dental, Exercise, Hearing testing, Hearing aids, Vision testing, Eyewear coverage.

• Consider alternative medicine coverage. Due to the opioid crisis, many Advantage Plans are adding chiropractors, naturopaths, Acupuncturists, and Massage therapists to deal with chronic pain.

• Prepare to annual evaluate the action plan and other products on the marketplace. As life situations change, your health coverage may need to change as well.

Our focus is deep. Our perspective is wide. The landscape is rugged. Together we survey the entire landscape to pick the best route to your destination.