Decisions, decisions

If this is your first time shopping for health insurance it can be confusing, if not overwhelming.

Seniors who are seasoned health insurance shoppers can have trouble understanding the differences for the new plan year.

And, as if understanding your own needs isn’t enough, then you have to navigate the different insurance companies to pick a carrier.

If you aren’t a Senior, but you’re trying to help a parent or parents with their Medicare selection, you’ll find yourself in a new world. Medicare is different from individual or group health insurance. You may jump in thinking it will be the same as choosing your own health insurance. But you’ll quickly realize requirements and terminology are all different.

Where do you begin?

Talk to an expert.

Our Medicare Products Specialists are experts and are licensed to sell all of the major carriers in the market place. They understand the difference between products AND the difference between carriers. And, their help is free.

Whether you choose to consult with an agent or decide to go it alone, you should do the following.

If you already have coverage…

and you’re trying to decide between keeping your current plan and switching plans or insurers, you should begin with reviewing your 2020 coverage.

  • Were there doctors you needed to see but couldn’t?
  • Were there benefits that weren’t covered?
  • Did you spend more out of your own pocket than you expected?
  • Did you experience unexpected gaps in coverage?

If you intend to meet with an agent, these questions will help you prepare for your meeting so you will be better able to tell your agent what you’re looking for. If you plan on going it alone, these questions will help you determine whether you want to look for a new plan or carrier or not.

If you’re a first time shopper…

The following is a list of key topics you’ll want to consider. Depending on your needs, the order of importance may differ for you.

Does the plan have a provider network?

If so, are your doctors in that network? If you go straight to looking at the price comparisons between carriers, you may pick one that fits into your budget but doesn’t allow you to actually see any of your doctors. If you’re healthy, that may be okay for you; You may be able to change doctors with ease. If you have a chronic condition(s), it could be extremely inconvenient.

What’s the premium?

This may be one of the easier boxes to check off your list. If you have a limited budget, certain plans may simply fall out of your budget. If you aren’t limited, you may have a threshold set that makes it easy for you to draw the line between plans.

Compare out-of-pocket costs

Premiums are not the only cost that you’ll experience. Out-of-pocket costs are any costs that you pay out of your own pocket. Two plans may have the same premium so, they may initially look similar. But after closer evaluation you may find that one has a $500 deductible and the other a $1,000 deductible.

It’s important to compare how much you’ll actually pay out-of-pocket. You may budget according to the premium and find that you don’t have the ongoing income to meet all of the different costs that you’re expected to pay.

Compare covered benefits

If you have a specific condition, is there a difference in coverage between plans? Some plans may completely exclude some services. Others may give discounted benefits for care related to a chronic condition. It’s important for you to review services that you use on an ongoing basis and see what you’ll pay for those services or, if services are actually excluded by a plan.

Plan structure

The two most common types of plan structures for Medicare Advantage are HMO and PPO. An HMO requires you to have a primary care doctor who gives you a referral to a specialist when you need it, and only provides benefits within a specific provider network. A PPO is more flexible. You can receive care in or out of the plan’s provider network, but your benefit level will change accordingly. And, you generally do not need a referral to a specialist, as long as they are in the plan’s provider network. Plan structure can be very important for individuals with chronic conditions or specific health requirements.

Get personal

Once you’ve reviewed the above points and narrowed down your search, ask specific questions about your care and your lifestyle. For example:

  • I take X medication. Is it covered and how?
  • I travel a lot. What happens if I get sick when traveling?
  • I have X. Which drugs for X disease are covered under this plan?
  • I live in the South during the winer months. Is that okay?

Choosing a Medicare Supplement or Medicare Advantage plan involves a lot of investigation. You need to investigate your own health needs and you need to investigate the different plans that are available to you. Give yourself peace of mind. Reach out to one of our experts for help.

Meeting with an agent to discuss your plan is completely free. And you pay nothing to enroll through an agent. We’re here only to help you make the best decision for your situation. You can call our general office number, 412-505-8302, to schedule an appointment with the first available agent, email us, or contact one of our agents directly.