Selecting your own Medicare Insurance

The following are areas where you should pay particular attention as you’re considering your Medicare options. This information will be most helpful when you are approximately six months away from becoming Medicare eligible, and making your Medicare insurance decisions.

When you are ready to compare Medicare plans or enroll in coverage, we recommend working with an independent insurance agent, also referred to as a broker. There are several reasons for this:

• An independent insurance agent represents multiple Medicare insurance companies, including Medicare Advantage, Medigap, and Medicare Prescription Drug plans, and their job is to help you understand the differences. Should you call a Medicare insurance company directly, you will usually be talking with an agent that sells for only one insurance company. This limits the information they can provide to that one company, and they cannot speak to the strengths and deficiencies of Medicare plans offered by multiple insurance companies.
• Independent insurance agents will verify that the Medicare plan you are considering is accepted by all of your healthcare providers.
• Your agent will be available each year during the Medicare Annual Enrollment Period. Hopefully, you will not need to change Medicare plans frequently, but you need to remember Medicare plans can change their benefits, network, and/or monthly plan premiums each year. Having a broker is like having an advocate by your side.
• When your independent insurance agent helps you enroll in the Medicare plan of your choice, their services are at no cost to you because they are paid directly by the insurance company you choose.

When considering an independent insurance agent, make sure they are highly-trained in Medicare, they represent a variety of Medicare Advantage, Medicare Supplement, and Prescription Drug plans without bias toward one type of plan, and they take the time to confirm your healthcare providers accept the coverage you are considering.

Do you already have an independent insurance agent? MedicareOnDemand will notify your agent and link them to our helpful Medicare resources. Click here to provide your agent’s information.

(links to jot form requiring: patient name, agent name, agent email, agent phone)

Your Takeaway:

Choose a licensed and highly-trained, independent insurance agent representing many different Medicare plans accepted by your healthcare providers. Your agent becomes your advocate, and they will help you understand your options now and each year during the Medicare Annual Enrollment Period. MedicareOnDemand connects you with licensed insurance agents that meet this criteria. 

Almost all Medicare Advantage (MA) plans being sold today have a network of contracted healthcare providers. If you chose an MA Health Maintenance Organization (HMO), you will usually be required to only use network providers for non-emergency healthcare services. If you chose an MA Preferred Provider Organization (PPO) you will usually pay higher out-of-pocket costs when going to non-network healthcare providers for non-emergency services.

Some MA PPOs may offer the same member cost-sharing, regardless of whether you are seeing network providers or non-network providers. But understand, non-network providers are not contracted with your plan, so they are not in partnership with your Medicare insurance company. This could result in slower approval times for services or even denied claims if the Medicare plan and your provider are not accustomed to working together.

Your Takeaway:

It is generally not a good idea to join an MA HMO or PPO if your physicians and hospital are not clearly listed as network providers. Make sure you confirm this before you apply for coverage. MedicareOnDemand insurance agents always confirm provider network participation.

When you first become eligible for Medicare Part B, you receive a six-month Medigap Open Enrollment Period that provides guarantee acceptance by any company selling Medigap insurance. Once this period ends, you will most likely need to pass the health insurance underwriting requirements of the insurance company that you are applying.

Your Takeaway:

Going on Medicare for the first time provides a unique opportunity to qualify for a Medigap plan without medical underwriting.  This may be the only time this occurs in your life. 

If you are interested in Medicare Advantage (MA), be sure to take the time to carefully review the MA Summary of Benefits with your insurance agent. As example, notice the cost-sharing requirements for outpatient services and lab work. Any time your financial requirement is a percentage (%) of approved charges, instead of a fixed dollar copayment ($), understand this may cause you to incur substantial out-of-pocket costs. All MA plans include an Annual Out-of-Pocket Maximum for qualified healthcare expenses, but the limit is almost always thousands of dollars per year, and it resets each January 1st.

Your Takeaway:

Saving money on your monthly plan premium may be financially beneficial, but take the time to understand the member copayments and cost-sharing before you join any Medicare Advantage plan. Avoid being surprised down the road. 

If you choose a Medicare Advantage HMO or PPO plan that includes prescription drug coverage, it is important to know you cannot choose another company’s Medicare Prescription Drug plan. Patients requiring a specific and expensive name brand drug, may find the drug is not covered by the MA plan’s formulary (list of approve drugs). For this reason, patients may choose Medigap instead of MA, since Medigap allows for purchase of a standalone Medicare Prescription Drug plan.

Your Takeaway

If you are considering an MA HMO or PPO, be especially careful to verify all expensive name brand medications are covered by the plan’s formulary. Keep in mind, should you select a standalone Medicare Prescription Drug plan, you will automatically disenroll yourself from any MA HMO or PPO. 

If you are a snowbird, love to cruise, or split your time between states, make sure you understand how your Medicare plan benefits work when you are away from home. It may be advisable to consider joining a Medigap plan instead of Medicare Advantage, if you often receive healthcare services when traveling. Please note, all Medicare Advantage plans provide Emergency Care when traveling.

Your Takeaway

Medicare Advantage plans may be more restrictive or cost you more out-of-pocket, should you need non-emergency healthcare services when away from home and unable to access the MA plan’s network providers.

This is important terminology to understand, if you are joining a Medicare Advantage plan. Most Medicare Advantage plans require members to receive Prior Authorization BEFORE many procedures or tests can be performed. If you do not receive Prior Authorization in advance, the MA plan may deny paying the claim.

Your Takeaway

If you choose a Medicare Advantage plan, be prepared for the need of receiving Prior Authorization before receiving many tests or procedures.

This concludes the Medicare patient orientation. We encourage patients to take full advantage of all MedicareOnDemand resources.

MedicareOnDemand is a non-government site hosted by MedicareCompareUSA, an independent health insurance agency not affiliated with the federal Medicare program. All services are provided at no cost and without obligation; MedicareCompareUSA and affiliated agents are paid directly by the Medicare plan when enrollment occurs. Healthcare providers receive no financial benefit when patients use the service. We do not offer every plan available in your area. Currently we represent 6 organizations which offer 24 products in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.