Which Medicare Plan is the Best for You?

Hey! Good afternoon– actually, good evening, it’s dark here. I wanted to talk to you about a couple things, plus I wanted to get my beard on camera, so I have it for posterity’s sake. 

So listen, I get a lot of questions from clients– from potential clients– about, “How do you compare plans? How do you decide on how to pick a plan? What are some of the things I need to be thinking about as I get ready to go on Medicare? Or, if I’m already on a Medicare plan, how do I compare the different plans?”

So, I want to talk to you tonight real briefly, real quick, about some of the things that I talk about when I talk to a client for the first time, or it’s time for review of their current plans. So a couple things that really make a big difference in your Medicare coverage– if I could think of one thing– the number one thing is if people are on expensive prescriptions.

So, a lot of people have a little bit of an awakening when they move off of an employer-sponsored plan or they move off of an individual plan and on to Medicare. Sometimes, in many cases, they’re finding that their drugs are pretty similar to the cost or maybe even a little bit better. But in the case of some expensive drugs, like biologicals for people who have rheumatoid arthritis or Crohn’s Disease, people who are on an expensive blood thinner like Xarelto or Eliquis. They’ll find that when they go on Medicare, if they haven’t picked the right plan and haven’t done enough research, haven’t talked to someone who knows what they’re talking about, those new drugs can be really expensive. 

So, what we want to look at is your drug coverage. You want to put in all the prescriptions you’re looking at. As an example, in a lot of counties in the United States– in most counties– there’s 15, 20, 30 different what we call standalone prescription drug plans. Those are plans that are only covering drug coverage, and they start at seven or eight dollars in most counties, and go all the way up to a hundred or over one hundred dollars a month. So, based off of the drugs you are taking or the drugs you’d like to take, maybe your doctor has said “Hey, we want to try this new drug”, and it’s– you’re going on Medicare or you’re on Medicare– we can look at those drugs. We can do comparisons. We’ve got some really great tools that give us the ability to compare plans. So, if you’re looking at a Medicare Advantage plan or prescription drug coverage, you want to look at your prescriptions. That’s a big deal.

Second: if you’re going on a Medicare Advantage plan, or a Medicare supplement for that matter, we want to make sure that the doctors that you want to see or you were seeing, and the facilities, the providers, the chiropractors, the physical therapists that they’re contracted with (the Medicare Advantage plan if you’re going on HMO). If it’s not an HMO, we want to look at the doctor you’re seeing and if they take Medicare as your primary insurance. So, that’s the second thing. We want to look at the doctors that you see, we want to make sure that they’re contracted with whatever insurance you’re going to go with. So, those are the first two.

The number three thing is we want to take a look at the premium. You know, I’ll give you an example. Part of the current administration here in 2021– excuse me, 2020 going into 2021– they enacted some new coverage for things like diabetic medications and so we want to take a look at the plan that you’re using. Does it cover that drug? Well, a lot of people thought, including some of us insurance agents, that because the cost of those drugs are going to be less, based off of this new program, we wanted to take a look and say, “Okay, maybe we should move you to this new type of coverage that has this discount for diabetic drugs– insulin specifically– because that might lower your costs. What was interesting is, especially in southeast Idaho and some of the other rural counties, we found that if you had a plan that has a lower monthly premium that’s maybe half the price of another plan, and that lower monthly premium plan didn’t include that discount for those insulin drugs, it’s still a better option as far as cost per month if you’re on that one insulin drug.

Now again, premium is not the number one factor. You’ll notice I didn’t talk about it first. I don’t look at premium as the leading factor. In some cases it’s going to be a determining factor, but not always, so there’s lots of scenarios that we can look at your drug coverage and look at your doctor’s lists and make sure– and the premium for that matter– and make sure sure that we’re picking a plan and helping you, guiding you, to the right plan that’s going to help you. So when you’re looking at your coverage, whether you’re going on to Medicare for the first time or you’re already on a plan, you want to look at three things mainly. Now we’ll have a whole bunch of other things that we’re looking at, but your premium, your drug coverage, and the doctors that you want to see or the providers you want to see, those are big, big things. We want to make sure that the coverage you have covers all three of those.

We’ll have other things that we want to cover, like, do you want extra benefits? So, some plans include coverage for gyms, so if you want to go to a local in-network gym, they’ll cover your basic gym membership fee. Sometimes they cover things like dental– preventative and comprehensive. We have plans that will cover dentures! They don’t cover the whole amount, but they’ll cover a portion of it. We have plans to help with eyeglasses and hearing aids. We have plans for heaven’s sake that give you meals if you go into a hospital as an inpatient! They’ll send you fresh meals after your discharge. So, we can talk about a whole bunch of things; over-the-counter items, battery powered toothbrushes, heck, in the Midwest there’s even some plans that help you with the cost of cell phones and iPads. I mean there is all kinds of options, but, based off your needs, the plan you’re on– excuse me, the drugs you’re on– the doctors you see, those extra benefits you may or may not need, and your costs that are coming up. There is a whole long list of things that we as an agency are going to look at, but the real main things, if I had to give you three points to start with, would be your drug that you’re using, the doctors that you see, and the premium that you want to pay.

I’ll tell you this last thing– when I meet with somebody, a lot of times the comparison that we’re doing comes down to this: Would you rather pay more per month but very little when you use it, or would you rather pay less per month, but know that whenever you use it, you’re going to have to have some co-pays or coinsurance that you are responsible for? And we can help you make a good comparison and do a side-by-side comparison and look at those coverages and help you and guide you to a plan that you’ll feel comfortable with, give you great coverage, and make sure that you’re well taken care of and well served.