When you become eligible for Medicare and do not have the option of a retiree plan to cover your medical and drug needs, you have the choice of filling in the gaps of what Medicare doesn’t cover with a Medicare supplement/medigap policy and stand-alone drug plan /or/ selecting a Medicare Advantage (senior HMO) plan for you medical and drug needs.
Before making this decision, individuals should know whether all of their doctors are in the same medical group and take a Medicare Advantage plan. If they do, then making your selection of a Medicare Advantage plan should include consideration of (1) what is the maximum out of pocket cost you will pay for medical services for that Plan?; (2) what are the copays under that Plan for the services you anticipate needing during the calendar year? (3) are all of your drugs covered under the Plan(s) you are considering and at what cost?
If all of your doctors are not in the same medical group and/or don’t take a Medicare Advantage plan, do you want to change doctors or do you want to consider a Medicare supplement/medigap policy to allow you freedom of choice for your providers, keeping in mind that there is a premium for a Medicare supplement/medigap policy based on which plan you select and your age. In addition, you will want to know whether the provider accepts Medicare assignment (what Medicare determines to be what the cost for that service should be) or will you need coverage for “excess charges”? In addition, by selecting a Medicare supplement/medigap policy, you will need to also select a Part D stand-alone drug plan (unless you are a Veteran and your drugs will be supplied by the VA).
There are a number of areas to consider when determining which coverage will work best for you. Take the time to make the selection that will work best for your specific medical and prescription drug needs.