How to Shop


I’ve put together this short page on “How to Shop” because there are some considerations that are common to all products, and some that are specific to one product only. Skip down to whichever product you are interested in but be sure to pay attention to the “Overview” section just below.

Overview

First and perhaps most importantly, you should not make your purchasing decision based only on what you see advertised the most. Let me be quick to add that there is nothing necessarily wrong with any of the products you see advertised on television and one of them may in fact be the best solution for you. It’s just that you owe it to yourself to do a little more research than just flipping on the television set.

If you are just coming up on your 65th birthday, then your mailbox is probably overflowing everyday with printed material urging you to buy this Medicare Supplement or that Medicare Advantage Plan. And during Open Enrollment (October 15 to December 7) each year, you cannot get through 15 minutes of television without seeing a commercial from Humana or AARP. The prices on these products vary from state to state and the price your sister-in-law pays for her Humana plan in Nevada is probably not the price you will pay in Idaho.

You can purchase most of these plans either through an insurance agent or on your own. In most cases you can buy directly from the company offering the plan. The price will be the same whether you buy direct or use an insurance agent but I know some people really like the “do it yourself” approach. If you’re one of those folks, always start your research at Medicare.gov, the official government website because it is completely unbiased and will give you the complete picture of companies offering plans in your specific area. Then, drill down on the companies you find of interest, visit their websites to get information about the company itself and read their information on each plan. Also check the shopping tips below on the specific type of plan you are looking for.

If you don’t want to do your own research you can always contact an experienced agent who specializes in this type of coverage. In my case, you can contact me for an appointment by calling (208) 263-2194 or by using the Contact Form.

PDP (Prescription Drug Plans)

In addition to doing the basic research mentioned above, be sure to calculate how each of the plans you are considering will pay for your current drugs. This is very easy to do on Medicare.gov because you can enter each prescription, including dosage and frequency, and the website can calculate the total cost for each PDP plan. In addition, the website for each company should have its Drug Formulary available. This is the list of drugs that plan covers and shows what “tier” it has been assigned and also any limitations on the drug such as Pre-Authorization Required, Quantity Limitations, Step Therapy Required and so forth. The government provides a helpful e-booklet on these plans that you can download here: Your Guide to Medicare Prescription Drug Coverage.

MA/MAPD (Medicare Advantage Plans)

If the Medicare Advantage Plan you are considering covers drugs (MAPD), then see the advice above on drug plans above. In addition, be aware that many MA/MAPD plans are HMO’s (Health Maintenance Organizations) which means that you must specify a Primary Care Provider (PCP) and in some cases must have that PCP’s referral to see a specialist. Most of the MA/MAPD plans use provider networks so you want to check those networks to see if the providers you already use are in-network. With a PPO (Preferred Provider Organization) type plan you will pay a higher amount for using out of network providers. With an HMO, there might be no payment if you go out of network so be sure you are very comfortable with the network if that is the case. In most plans, Emergency or Urgent Care is covered as an in-network expense regardless of where in the country you receive the care. And, speaking of “in the country”, many of the plans offer limited coverage for emergency care received outside of the United States so if you travel a lot you should pay particular attention to that coverage.

Medicare Supplements (Medigap Plans)

Shopping for Medigap plans can seem a bit more difficult than shopping for MA/MAPD plans. That’s because although Medicare.gov will give you a list of all companies offering a particular plan in your area, you can’t actually compare prices without going to each company’s website. In addition, the government provides no Star Ratings for Medigap plans like they do for MA/MAPD plans so it’s up to you to try to determine the quality of a particular company or plan. The good news is that the plans are standardized by the government into 10 lettered plans (Plan C, Plan F, etc) so that, for the most part, if you are comparing one company’s Plan F against that of another company, it should be pretty close to an “apples to apples” comparison. One excellent source of research information that is provided by the government is the e-booklet Choosing a Medigap Plan which you can download by clicking the link.

Questions?

Call me for an appointment at (208) 263-2194 or use the Contact Form.