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Tag: Open enrollment

  • Medicare open enrollment: Can you buy supplemental insurance?

    Medicare open enrollment: Can you buy supplemental insurance?

    Harris Meyer writes for Kaiser Health News about the confusion surrounding the purchase of Medicare supplemental insurance for people who opt for traditional Medicare during the Medicare annual open enrollment period, which began October 15 and goes through December 7. Can you buy supplemental insurance? Whatever you do, don’t trust an insurance agent to advise you; rather go to your local State Health Insurance Assistance Program or SHIP, for free unbiased advice.

    If you have traditional Medicare, having supplemental insurance is necessary if you want to protect yourself from unlimited out-of-pocket costs. But, many people do not understand that or, if they do, might not be able to buy supplemental insurance. Supplemental insurance, which fills gaps in traditional Medicare, comes in three forms–retiree coverage from your former employer, Medicaid or an insurer in the individual market.

    Medicare supplemental insurance or “Medigap,” which you buy in the individual market, picks up a lot of the coinsurance costs and deductibles that people with traditional Medicare would otherwise have to pay. With it, you can sleep at night without worrying about out-of-pocket costs if you need hospital or medical care. You have the right to buy Medigap insurance during the six months after you first enroll in Medicare Part B.

    There are a series of standardized Medigap plans labeled A through N. They all cover the basic coinsurance costs for medical services. But, some also cover coinsurance for nursing home care and others pick up some of the hospital deductible as well. Some Medigap plans have lower premiums because they require you to pay a high deductible before coverage kicks in. Premiums differ depending upon the type of plan and insurance company offering it you choose.

    If you are in a Medicare Advantage plan and want to move to traditional Medicare, it is sometimes not possible to buy Medigap insurance. A lot depends on the state you live in. Some states guarantee you the right to buy Medigap coverage, no matter your age or health status–New York, Massachusetts, Connecticut and Maine. And, eight states, including those four, do not allow Medigap insurers to charge you more based on your health status or age.

    In most states, the Medigap premium charged and whether you can even buy Medigap coverage at all, depends on your health status. Medigap insurers are not likely to sell you insurance if they don’t have to and the insurance company believes you will incur large health care costs.

    There are a few other situations in which you can buy Medigap insurance, some under federal law and some under state laws. For example, you always have the right to buy a Medigap plan if you sign up for Medicare Advantage when you first enroll in Medicare and then decide you want to switch to traditional Medicare within 12 months. Many states also guarantee you the right to buy a Medigap plan if you lose your retiree supplemental coverage.

    Medigap premiums can easily be $1,500 or more a year and, if you are able to buy a policy after your initial enrollment period, the insurer can charge you more in most states, depending upon your health status. But, if you see a doctor or go to the hospital during the course of the year, you might spend less for the Medigap policy than you would for deductibles and copays in Medicare Advantage.

    Medicare Advantage plans, unlike Medigap plans in most states, cost the same for everyone, no matter their health status or age. That said, Medicare Advantage plans can charge you up to $7,550 a year out of pocket for in-network care alone, excluding prescription drugs.

    If you qualify for Medicare because of a disability, you have no right to buy Medigap coverage under federal law. Most states do require insurers to sell you a Medigap policy. But, 19 states do not. And, if you have end state renal disease–kidney failure–only 14 states give you the right to buy a Medigap plan.

    Contact your state health insurance assistance program or SHIP for guidance on buying a Medigap policy in your state. You can call 1-800-677-1116 for the phone number of your local SHIP.

    Here’s more from Just Care:

  • Medicare Open Enrollment: You could save big money on drugs

    Medicare Open Enrollment: You could save big money on drugs

    It’s Medicare open enrollment season, and if you’re smart you’ll take an hour or two to review your options. While it is not possible to choose a Medicare Advantage plan that is right for you—there are too many unknowns—you should be able to avoid choosing a Medicare Advantage plan that is wrong for you. And, you could save big money on drugs.

    Paula Span reports for The New York Times on one woman who saw hundreds of dollars in savings by choosing a particular Part D prescription drug plan and using that plan’s pharmacies. Especially if you are taking multiple medications, using the Medicare Part D Plan Finder can direct you to Part D plans that  cover the drugs you are currently taking at the lowest cost. Of course, if you are prescribed new expensive medicines after you sign up with a Part D plan, all bets are off.

    What should you do to lower your drug costs? First, make a list of all the medicines you are taking and your current copays. Then, go to the Medicare Part D Plan Finder to figure out which Part D plans offer you the least expensive coverage from pharmacies that you can easily use. Keep in mind that each Part D plan has different rules about where you can fill your prescriptions.

    What if you’re in a Medicare Advantage plan? The same rules apply. Each Medicare Advantage plan has its own formulary—list of covered drugs and copays—along with where you can fill your prescriptions. You want to check that the Medicare Advantage plan you choose will cover the drugs you use, in addition to your doctors and hospital, at a low price. If you are on multiple medications, to save money, you should look carefully at your drug costs in different Medicare Advantage plans.

    Can I get help choosing a Part D plan or a Medicare Advantage plan? Yes, free help is available through your local State Health Insurance assistance Program or SHIP. Call 877-839-2675 for information on your state’s SHIP. Do not rely exclusively on the advice of an insurance agent. Agents are paid more to steer you towards particular plans and might not direct you to the best plan for you.

    Here’s more from Just Care:

  • Don’t judge a Medicare Advantage plan by its stars

    Don’t judge a Medicare Advantage plan by its stars

    When you examine your Medicare plan options during this year’s open enrollment season, do not judge a Medicare Advantage plan by its stars. The government’s star-rating system is deeply flawed. Rather, you should assume that some plans with four and five-star ratings have high denial and mortality rates and low-quality provider networks.

    For sure, you should avoid Medicare Advantage plans with one and two-star ratings. They are few and far between. And, if the Centers for Medicare and Medicaid Services is giving them such a low rating, there’s a reason.

    But, the higher star-ratings are based on measures that can be extremely misleading. For one, the star ratings are determined on an insurer’s group of Medicare Advantage plans, at the Medicare Advantage “contract level.” If there’s a Medicare Advantage plan that’s performing poorly that is assessed with others that are performing better, that poor-performing Medicare Advantage plan will reap the star-rating of its fellow plans. And, people who join that poor-performing plan will have no clue.

    MedPac has proposed changing the star-rating program, which it says is “flawed.” It is “inconsistent with the [MedPac] Commission’s principles for quality measurement.” In addition to giving plans ratings based at the “contract level” and not the individual plan level, the Centers for Medicare and Medicaid Services (CMS) does not focus on population-based outcome and patient experience measures. In addition, plans are rated as compared with one another, not relative to objective performance targets. And, plans are not rated by subpopulations served, so there’s no way to know if a plan with a high rating is actually meeting the needs of its members with special needs and costly conditions.

    Another issue with the star-rating system is that it is not budget neutral. The more plans with four- and five-star ratings, the higher their payments. This means that Medicare Advantage plans are not operating on a level playing field with traditional Medicare.

    How should you choose a Medicare plan? If you want easy access to care from your choice of doctors anywhere in the US and few if any out-of-pocket costs, traditional Medicare is your best option. But, you will need supplemental coverage—Medigap, retiree coverage or Medicaid—to protect yourself financially. To choose a Medicare Advantage plan, talk to your doctor. Pick a plan that has the doctors you want to see and hospital you want to use in its network. And, keep in mind that if you need costly health care services, your out-of-pocket costs could easily be $5,000 for in-network care alone.

    Fierce Healthcare reports that, in 2022, almost seven in ten Medicare Advantage plans have a four-star or five-star rating. That’s up from not even five in ten in 2021.

    Here’s more from Just Care:

  • Medicare Open Enrollment in 2020

    Medicare Open Enrollment in 2020

    Medicare’s 2020 Open Enrollment period begins on October 15 and runs through December 7. If you are enrolled in a Medicare Advantage plan, a private health insurance plan that offers Medicare benefits, or in a Medicare Part D prescription drug plan, you should review your options. It could save you a lot of money.

    Unfortunately, you still cannot trust a lot of the information on the Medicare website during this Open Enrollment period. Much of the information on Medicare Advantage plans is misleading. CMS continues to steer people into these private Medicare plans without properly advising them of their risks or the benefits of traditional Medicare.

    Medicare Advantage and Medicare Part D prescription drug health plan costs and benefits often change significantly from one year to the next and network providers can change within the year. Although you can’t know whether a health plan will meet your future health care needs, you may be able to save money by switching. Before you make your choice, keep these facts in mind. Whichever Medicare plan choice you make, you need Medicare Parts A and B, so you must pay the Medicare Part B premium.

    • Traditional Medicare, the public health insurance option, the Medicare health plan choice for most people with Medicare
      • Traditional Medicare offers coverage from almost all doctors and hospitals anywhere in the country.
      • Traditional Medicare does not require pre-authorization or a referral for medical or hospital services.
      • With traditional Medicare, you can fill most, if not all, coverage gaps with supplemental insurance—Medicaid, retiree coverage from a job or “Medigap,” a Medicare supplemental insurance plan you can buy–all of which cover most or all of your deductible and coinsurance costs. Supplemental insurance protects you from catastrophic costs and allows you to budget for your health care.
    • Medicare Advantage plans, corporate health plans that contract with Medicare
      • Medicare Advantage plans generally restrict coverage to a small group of doctors and hospitals in your community—the provider network–except in emergencies or urgent care situations. The provider network can change at any time with doctors and hospitals leaving and entering the network.
      • Medicare Advantage plans sometimes charge an additional premium (on top of the Part B premium), a deductible (the amount you pay before coverage begins) and a copay or coinsurance, with each health care visit. The copay or coinsurance can be very high and unpredictable, a percentage of your hospital bill. And, in 2021, your out-of-pocket costs for in-network care alone can be as high as $7,550 a year. Your costs can change from one year to the next. You cannot buy insurance to fill these coverage gaps.

    Even if you don’t need a lot of health care today, who knows what curve balls life will bring. So long as you have traditional Medicare and supplemental coverage, you should be able to see most any doctor and use virtually any hospital to get the care you need, with little or no out-of-pocket costs. With Medicare Advantage plans, you have only restricted access to doctors and hospitals and your out-of-pocket costs can easily reach the $6,700 limit for in-network care. Your costs can be even higher if you are hospitalized and are forced to use out-of-network doctors, a fairly common phenomenon, or if you want to use specialists out of network.

    FYI: Medicare Advantage won’t release data showing people’s typical out-of-pocket costs. However, we know from the HHS Office of Inspector General that Medicare Advantage plans engage in widespread inappropriate denials of care and coverage. And we know from this new paper that people who enroll in Medicare Advantage plans with high mortality rates, have a greater risk of dying.

    If you’re in a Medicare Advantage plan now, keep in mind that they are not standardized, costs and coverage are always changing and, it is impossible to know what treatments your plan will be cover and what you will pay. Delays and denials are common and out-of-pocket costs can be sky high.

    • Check your health plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays. If those are good with you, also call your doctors and check with your health plan to make sure your doctors and hospital are still in the network.
    • Consider your other health plan options, including traditional Medicare. One of those options may better meet your needs. You can call your State Health Insurance Program or SHIP for help sorting through your options. You can also call 1-800-633-4227 (1-800-Medicare) or use this Medicare tool to understand your options.
    • Before making a switch to another Medicare Advantage plan, call the plan to confirm your understanding of costs and network doctors and hospitals.
    • If you want to switch to another Medicare Advantage plan, call 1-800-633-4227 (1-800-Medicare) to let Medicare know about your decision.

    If you have a Medicare Part D prescription drug plan:

    • Check your Part D drug plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays or coinsurance. If those seem good to you, check the costs for the drugs you’re taking.
    • It’s wise to look at other Part D drug plan options. You might find a plan that covers your drugs at lower cost. Medicare offers a tool for comparing drug plans based on your drug needs.

    If you decide to switch Medicare Advantage or Medicare Part D prescription drug plans, your new coverage will begin on January 1. Even if you don’t switch now, after the open enrollment period ends, if you are enrolled in a Medicare Advantage Plan and would like to disenroll and switch to traditional Medicare, you may be able to do so between January 1 and February 14. To learn more and get free advice, call your State Health Insurance Assistance Program at 800-677-1116.

    For free assistance, contact your State Health Insurance assistance Program (SHIP) (1-800-677-1116) or the Medicare Rights Center at 800-333-4114.

    Here’s more from Just Care:

  • Medicare Open Enrollment in 2019

    Medicare Open Enrollment in 2019

    Medicare Open Enrollment begins on October 15 and runs through December 7. Whether you are enrolled in traditional Medicare and have a Part D prescription drug plan or you are in a commercial Medicare Advantage plan, your premiums and other out-pocket-costs and in-network providers are likely changing. So, it’s wise to take a hard look at your Medicare options for next year.

    Medicare Advantage and Medicare prescription drug health plan costs and benefits often change significantly from one year to the next. Although you can’t know whether a health plan will meet your future health care needs, you may be able to save money by switching.

    Before you make your choice, keep these facts in mind. Whichever Medicare plan choice you make, you need Medicare Parts A and B, so you must pay the Medicare Part B premium.

    • Traditional Medicare, the government health insurance option, the Medicare health plan choice for nearly seven in ten people with Medicare
      • Traditional Medicare offers coverage from almost all doctors and hospitals anywhere in the country.
      • Traditional Medicare generally does not require pre-authorization or a referral for medical or hospital services.
      • With traditional Medicare, you can fill most if not all coverage gaps with supplemental insurance—Medicaid, retiree coverage from a job or “Medigap,” a Medicare supplemental insurance plan you can buy–all of which cover most or all of your deductible and coinsurance costs. Supplemental insurance protects you from catastrophic costs and allows you to budget for your health care.
    • Medicare Advantage plans, commercial health plans that contract with Medicare
      • Medicare Advantage plans generally limit coverage to a small group of doctors and hospitals in your community—the provider network–except in emergencies or urgent care situations. The provider network can change at any time with doctors and hospitals leaving and entering the network.
      • Medicare Advantage plans often charge an additional premium (on top of the Part B premium), a deductible (the amount you pay before coverage begins) and a copay or coinsurance, with each health care visit. The copay or coinsurance can be very high and unpredictable, a percentage of your hospital bill, and your out-of-pocket costs for in-network care alone can be as high as $6,700 a year. Your costs can change from one year to the next. You cannot buy insurance to fill these coverage gaps.

    If you need costly Medicare-covered services, so long as you have traditional Medicare and supplemental coverage you should be able to see most any doctor and use virtually any hospital to get the care you need with little or no out-of-pocket costs. With Medicare Advantage plans, you have only restricted access to doctors and hospitals and your out-of-pocket costs can easily reach the $6,700 limit for in-network care. Your costs can be even higher if you are hospitalized and are forced to use out-of-network doctors, a fairly common phenomenon, or if you want to use specialists out of network. FYI: Medicare Advantage won’t release data showing people’s typical out-of-pocket costs. However, we know from the HHS Office of Inspector General that Medicare Advantage plans engage in widespread inappropriate denials of care and coverage.

    Keep in mind that even if you need few health care services today, it’s unforeseeable when you might need a lot of care.

    If you’re in a Medicare Advantage plan now:

    • Check your health plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays. If those are good with you, also call your doctors and check with your health plan to make sure your doctors and hospital are still in the network.
    • Consider your other health plan options, including traditional Medicare. One of those options may better meet your needs. You can call your State Health Insurance Program or SHIP for help sorting through your options. You can also call 1-800-633-4227 (1-800-Medicare) or use this Medicare tool to understand your options.
    • Before making a switch to another Medicare Advantage plan, call the plan to confirm your understanding of costs and network doctors and hospitals.
    • If you want to switch to another Medicare Advantage plan, call 1-800-633-4227 (1-800-Medicare) to let Medicare know about your decision.

    If you have a Medicare Part D prescription drug plan:

    • Check your Part D drug plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays or coinsurance. If those seem good to you, check the costs for the drugs you’re taking.
    • It’s wise to look at other drug plan options. You might find a plan that covers your drugs at lower cost. Medicare offers a tool for comparing drug plans based on your drug needs.

    If you decide to switch plans, your new coverage will begin on January 1. Even if you don’t switch now, after the open enrollment period ends, if you are enrolled in a Medicare Advantage Plan and would like to disenroll and switch to traditional Medicare, you may be able to do so between January 1 and February 14. To learn more and get free advice, call your State Health Insurance Assistance Program at 800-677-1116.

    Here’s more from just Care:

  • New Medicare Advantage Open Enrollment Period: January through March

    New Medicare Advantage Open Enrollment Period: January through March

    Beginning in January 2019, there is a new Medicare Advantage Open Enrollment Period (MAOEP). You have the right to leave your Medicare Advantage plan and enroll in traditional Medicare and Medicare Part D between January 1 and March 31 of each year. This right is in addition to your right to switch Medicare plans during the Fall annual Open Enrollment Period.

    The Medicare Advantage Open Enrollment Period allows anyone in a Medicare Advantage plan to switch to traditional Medicare or another Medicare Advantage plan. If you are enrolled in traditional Medicare, you do not have the right to switch to a Medicare Advantage plan during the MAOEP.

    If you switch out of your Medicare Advantage plan into a new Medicare plan, your coverage in the new plan will begin on the first day of the following month. If you want to switch to traditional Medicare, make sure that you have supplemental insurance to fill gaps in coverage. If you have Medicaid or retiree coverage that wraps around traditional Medicare, you are set. If you need to buy the coverage, sometimes called “Medigap,” contact your State Health Insurance Assistance Program (SHIP) at eldercare.gov to find out what coverage is available to you.

    Here’s more from Just Care:

  • 2018 Medicare Open Enrollment

    2018 Medicare Open Enrollment

    Medicare Open Enrollment began on October 15 and runs through December 7. If you are enrolled in a Part D prescription drug plan or a Medicare Advantage plan, your out-pocket-costs and/or in-network providers may be changing. It’s wise to take a hard look at your Medicare options for next year.

    Health plan costs and benefits often change significantly from one year to the next. So, you may want to switch. Although it’s hard to know whether a health plan will meet your future health care needs, you may be able to save money by switching.

    Even if you don’t switch now, after the open enrollment period ends, if you are enrolled in a Medicare Advantage Plan and would like to disenroll and switch to traditional Medicare, you may be able to do so between January 1 and February 14. To learn more and get free advice, call your State Health Insurance Assistance Program at 800-677-1116.

    Before you make your choice, keep these facts in mind.

    • Traditional Medicare, the government health insurance option, is the Medicare health plan choice for nearly seven in ten people with Medicare.
      • Traditional Medicare offers coverage from almost all doctors and hospitals anywhere in the country.
      • Traditional Medicare generally does not require pre-authorization or a referral for medical or hospital services.
      • With traditional Medicare, you pay deductibles and coinsurance in addition to the Part B premium. However, you can fill most if not all coverage gaps with supplemental insurance—Medicaid, retiree coverage from a job or a Medicare supplemental insurance plan you can buy. Supplemental insurance protects you from catastrophic costs and allows you to budget for your health care.
    • Medicare Advantage plans, commercial health plans that contract with Medicare
      • Medicare Advantage plans generally limit coverage to a small group of doctors and hospitals in your community—the provider network–except in emergencies or urgent care situations. The provider network can change at any time with doctors and hospitals leaving and entering the network.
      • Medicare Advantage plans often charge an additional premium (on top of the Part B premium), a deductible (the amount you pay before coverage begins) and a copay or coinsurance, with each health care visit. These costs can change from one year to the next. You cannot buy insurance to fill these coverage gaps.

    If you need costly Medicare-covered services, so long as you have traditional Medicare and supplemental coverage you should be able to see most any doctor and use virtually any hospital with little or no out-of-pocket costs. With Medicare Advantage plans, you will have only restricted access to doctors and hospitals and your out-of-pocket costs can easily reach the $6,850 limit for in-network care. Your costs can be even higher if people are hospitalized and are forced to use out-of-network doctors, a fairly common phenomenon, or if people want to use specialists out of network.

    If you’re in a Medicare Advantage plan now:

    • Check your health plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays. If those are good with you, also check to make sure your doctors and hospital are still in the network.
    • Consider your other health plan options, including traditional Medicare. One of those options may better meet your needs. You can call your State Health Insurance Program or SHIP for help sorting through your options. You can also call 1-800-633-4227 (1-800-Medicare) or use this Medicare tool to understand your options.
    • Before making a switch to another Medicare Advantage plan, call the plan to confirm your understanding of costs and network doctors and hospitals.
    • If you want to switch to another Medicare Advantage plan, call 1-800-633-4227 (1-800-Medicare) to let Medicare know about your decision.

    If you have a Medicare Part D prescription drug plan:

    • Check your Part D drug plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays or coinsurance. If those seem good to you, check the costs for the drugs you’re taking.
    • It’s wise to look at other drug plan options. You might find a plan that covers your drugs at lower cost. Medicare offers a tool for comparing drug plans based on your drug needs.

    If you decide to switch plans, your new coverage will begin on January 1.

    Here’s more from just Care:

  • Your right to buy Medigap coverage

    Your right to buy Medigap coverage

    People with Medicare have the right to switch Medicare plans, from a Medicare Advantage plan to traditional Medicare or vice versa, every year during the Fall open enrollment period. But, inexplicably, people do not have a right to buy Medigap coverage, supplemental coverage to fill gaps in Medicare, whenever they sign up for traditional Medicare. Without supplemental coverage, either Medigap, Medicaid or retiree coverage, you have no protection against catastrophic costs in traditional Medicare. A new Kaiser Family Foundation brief explains the issue in detail.

    Under federal law, only people first enrolling in traditional Medicare at 65 or later have the right to buy a Medigap policy. People under 65 with disabilities enrolled in Medicare do not have that right. In fact, only five percent of them have a Medigap policy. (Even though insurers do not have to sell them a policy, some do.) Most (46 percent) have Medicaid. And, 17 percent have employer coverage to fill gaps.

    People in a Medicare Advantage plan who want to switch to traditional Medicare also have no guaranteed right to buy a Medigap policy under federal law. Curiously, Congress gives these people the right to switch to traditional Medicare during the Fall Open Enrollment period but no limit on their out-of-pocket costs in traditional Medicare and no right to buy coverage to protect themselves against catastrophic costs.

    States have the right to guarantee their residents broader Medigap protections than the federal government. But, most states have never been good at protecting consumers in the health insurance marketplace. So, in most states, you should not assume you can get a Medigap policy if you do not get it when you first enroll in Medicare at 65 or later. Though, twenty-eight states do guarantee people the right to buy a Medigap policy if their employer retiree benefits change.

    If you want to sign up for traditional Medicare during the fall open enrollment season, keep in mind that some insurers are willing to sell people Medigap coverage even though they are not required to do so. AARP plans are often available to people. Contact your state health insurance assistance program or SHIP at 1-800-677-1116 for free advice on whether there are Medigap companies in your state that will sell you coverage.

    Four states give people the guaranteed right to buy a Medigap policy, regardless of their health status. Connecticut, Massachusetts, Maine and New York protect people with Medicare. In these states insurers must sell you a Medigap policy even if you have a pre-existing condition. These states also require “community rating” of Medigap policies so that regardless of your age or health, everyone pays the same premium.

    Congress imposed a catastrophic out-of-pocket limit in Medicare Advantage plans, of no more than $6,700, in recognition of the need to give people enrolled in these plans some health and financial security. Congress should impose an out-of-pocket limit in traditional Medicare–or, better still, eliminate deductibles and coinsurance–to protect people in traditional Medicare. Congress should also require Medigap plans in all states to guarantee coverage to everyone during the Fall open Enrollment period and charge everyone the same amount. After all traditional Medicare and Medicare Advantage plans are all community rated–everyone pays the same premium for their policy.

    Here’s more from Just Care:

  • Two tips to help you choose a health plan

    Two tips to help you choose a health plan

    During open enrollment season, many of us struggle to figure out which health plan to choose. People typically remain in their current health plans because that’s generally the easiest choice to make (it may also be our only choice).  But, it may not be the wisest. Your plan costs and benefits may be changing. And, there may be a better, less expensive plan, available to you.

    How do you choose a health plan? If you have Medicare, most people choose traditional Medicare, the public health plan administered by the federal government, because it covers your care from virtually any doctor or hospital in the U.S. And, so long as you have supplemental coverage, almost all of your costs are covered. Here are four tips to consider before choosing between traditional Medicare and a Medicare Advantage or private Medicare plan. If you are choosing among different private health plans–employer plans, exchange plans or Medicare Advantage plans–because you generally will not know your future health care needs or what services the health plan will cover and what you will need to pay out of pocket, it’s really not possible to choose a health plan that you can be sure will meet your needs.

    Here are two factors to consider:

    1. Your doctors and hospital: If you have doctors you know and trust, you likely want to call them to find out which health plans they are enrolled in and narrow down your options to those health plans. Keep in mind that doctors may switch from one health plan to another at any time during the year, so don’t assume that your doctor will remain in your health plan.  Also, if you travel a lot or live in different places at different times of the year, you probably want a health plan that will cover your care wherever you are. Traditional Medicare covers your care anywhere in the United States. Commercial (private) health insurance often limits your coverage to a particular geographic network and does not usually cover out-of-network care, except in emergencies. If you have Medicare, here are two questions to answer during the open enrollment period.
    2. The premium, deductible and copays: When you compare health plans based on costs, be sure to look at the deductible—the amount you pay out of pocket before coverage begins—as well as the premium and copays. Often health plans with low premiums have high deductibles and, if you do end up needing health care services, your costs can be far higher in one of those plans than in a health plan with a higher premium and a lower deductible. For example, a health plan with a $200 monthly premium and a $2500 deductible is effectively charging you $4900 for the year ($2400 plus $2500) if you need a bunch of health care services. A health plan with a $250 monthly premium and a $1000 deductible will cost you $4,000 for the year ($3000 plus $1000). Copays, the amount you pay out of pocket for a doctor’s visit can also add significantly to your costs if they are high and you have a complex condition that needs a lot of care. Keep in mind that your annual out-of-pocket cap can be quite high–it’s as much as $6,850 in a Medicare Advantage plan in 2016. For a crash course on five important health insurance terms, click here.

    Note: If you are enrolled in a Medicare Advantage Plan and would like to switch to traditional Medicare, you can until February 14. To learn more and get free advice, call your State Health Insurance Assistance Program.

    Here’s more from Just Care: