WHEN, WHY & HOW TO CHOOSE A PLAN THAT’S RIGHT FOR YOU
ARI BAUM, CFP®
WHETHER YOU’RE LOOKING INTO MEDICARE FOR THE FIRST TIME, OR WANT TO UPDATE YOUR STRATEGY, WE’VE BROKEN DOWN THE CRITICAL CHOICES YOU MUST MAKE INTO A SIMPLE DECISION-MAKING TOOL (INCLUDING THE EASY-TO-UNDERSTAND QUESTIONS YOU MUST ASK YOURSELF BEFORE CHOOSING A PLAN).
Getting the answers wrong can cost you big-time! Not only is healthcare likely to be your largest expense in your retirement (potentially $300,000 or more), but nearly every American over age 65 must eventually enroll in Medicare.
Making the wrong choices could cost you thousands in permanent penalties, leave you facing high medical bills without coverage, or force you into a too-expensive plan.
WHEN TO ENROLL
Are you at least 65? Unless you qualify for disability, you typically don’t qualify for Medicare until age 65. Are you covered by employer-sponsored or retiree health insurance? If so, and your employer has at least 20 employees, you may not need to enroll in Medicare yet.
Do you qualify for VA benefits or TriCare? If so, you may still need to enroll in Medicare Part B because VA and Medicare benefits do not overlap.
Warning! If you are eligible for Medicare coverage and are not covered by qualifying insurance, you should consider enrolling in Medicare ASAP to avoid late enrollment penalties and higher premium costs.
WHY CHOOSE A MEDICARE PLAN?
What Medicare plan is right for me?
Choosing a Medicare plan means balancing priorities and knowing what’s most important to you. Remember—there are no right or wrong answers to the following questions.
Choosing between Original Medicare (Parts A + B) and a Medicare Advantage Plan (Part C).
• I already have doctors and specialists, and don’t want to switch.
• I travel away from home and want coverage that spans the entire United States.
• I value the freedom to visit almost any doctor, hospital, and medical provider that accepts Medicare.
You Should Consider Original Medicare Part A (Hospital Insurance) + Part B (Medical Insurance)
• I don’t mind going through a primary care physician to see specialists.
• I stay close to home and can find a doctor within my network.
• I value simplicity and don’t want to manage multiple insurance plans.
You Should Consider a Medicare Advantage Plan (Part C)
Part A covers hospitals, rehab, and hospice care, whereas Part B covers doctor visits, lab tests, screenings, and other outpatient services. While Part A is free for most people, you’ll pay monthly premiums for Part B plus deductibles, copays, and coinsurance.
Pros: You have the freedom to visit any provider or hospital in the U.S. that participates in Medicare and you don’t need to work with a primary care physician to see specialists. This flexibility is ideal if you travel outside of your home network or have existing relationships with doctors you want to keep.
Cons: Services have deductibles and copays, which may require you to purchase a Medigap or Medicare Supplement Plan to control your out-of-pocket spending. You will also need to purchase prescription drug coverage (Medicare Part D) separately.
Offered through private insurers, Part C is often structured like an HMO or PPO and provides comprehensive health coverage combining Parts A and B.
Pros: Many Part C plans cover extra services like vision, hearing, and dental and may include prescription drug coverage. Plans have an annual limit on your total out-of-pocket costs.
Cons: In addition to paying a part B premium, you’ll typically pay an extra monthly premium for the Medicare Advantage plan. Networks change, doctors can leave, and benefits can change over time.
Choosing Original Medicare (Parts A + B)?
Since it doesn’t cover prescription drugs, you automatically need Medicare Part D.
You’ll need to sign up as soon as you become eligible for Medicare, even if you don’t use prescription drugs, to avoid paying late enrollment penalties.
Pros: Copays and other plan details vary by state and insurer, but they will cover most of the cost of your prescriptions.
Cons: After exceeding coverage limits, you’ll pay the full cost of your medications until a Medicare threshold is reached.
Let’s see if you need supplemental insurance to lower your out-of-pocket costs.
Do you have retiree coverage through the military or a private company? Eighty-one percent of Original Medicare participants had some type of supplemental coverage.
If not, you may want to consider a Medicare Supplement Plan or Medigap.
What is it? Private insurance that fills the coverage gaps in Parts A and B of Medicare and helps with deductibles, copays, coinsurance, etc.
Pros: It limits your out-of-pocket costs for Original Medicare.
Cons: There are many different types of Medigap plans, all with different details.
Choosing a Medicare Advantage Plan (Part C)?
You’ll need to determine whether prescription drug coverage is included. Most Medicare Advantage plans include prescription drug coverage, though not all do. Read your policy documents carefully.
HOW TO DECIDE
You don’t need to make critical Medicare decisions by yourself.
As a taxpayer, you’ve earned the right to your Medicare benefits. If this guide hasn’t given you 100% confidence in your next steps, you don’t need to go it alone. All you need to do is contact Medicare at 1-800-MEDICARE or 1(800) 663-4227.
Right now, you might be asking yourself questions like:
• How do I enroll?
• When is my next enrollment period?
• Which doctors and hospitals will take my plan?
• How much are my premiums, deductibles, and services going to cost?
• How do I balance coverage with price?
• Do I have to medically qualify?
You can find the additional answers and support at www.medicare.gov.
The content aterial is developed from sources believed to be providing accurate information. Consult your financial professional before making any investment decision. Investing involves risk including the potential loss of principal. No investment strategy can guarantee a profit or protect against loss. Past performance does not guarantee future results.
Ari Baum, CFP® is the founder and CEO of Endurance Wealth Partners, with over 25 years of experience in the Financial Services industry. He brings his in-depth experience to Conceive. Believe. Achieve. for his clients.
Securities and Advisory services offered through Prospera Financial Services Inc. Member FINRA/SIPC. Brokerage and Advisory accounts carried by Wells Fargo Clearing Services, LLC
