If you are or will soon be 65 or older, you’re probably eligible for Medicare.
To lower potential out-of pocket expenses, most people supplement their basic government plan with insurance from Medicare-approved private companies that provide significant benefits not covered by Medicare. Even if you already have a plan that you like, you have between now and Dec. 7 to see if you can find an even better plan. Benefits and premiums change, so it’s worth comparing your current plan with other options.
If you’re like me, you may have been inundated with mailers and TV commercials from companies that want your business. They all offer compelling reasons to sign-up or switch, but thanks to a government website, you don’t need to rely on their advertising. Medicare.gov has a tool that will tell you exactly what it will cost in premiums and medical fees for doctor’s visits, procedures and prescription drugs. There are also commercial sites that let you comparison shop and sign up for Medicare plans, and there are websites operated by individual insurance companies that will lay out costs and benefits in their own words. As I’ll explain, the Medicare website is very specific. It asks about age, gender, location and the drugs you take.
Before I go on, I have to say that Medicare is the best health insurance program I’ve ever used. Not only is it affordable for most Americans, it has the best customer service I’ve experienced. Medicare.gov is an incredibly well-crafted website that includes a live chat feature, which I’ve used several times to get answers to questions about premiums, benefits and specific claims. In most cases, my wait time was less than a minute. The human on the other end has always been helpful and courteous. Some people like to complain about government services, but several people I’ve spoken with rave about Medicare.
Comparing plans
The government website will compare both health and drug plans and let you choose between a Medicare Advantage Plan (Part C) or a Medigap policy (also called a Medicare Supplement plan), which is extra insurance you can buy from a private company to help pay your out-of-pocket costs that the government’s Medicare plan doesn’t cover. Most Medigap policies don’t include prescription drug plans, but if you opt for Medigap, you can also sign up for Medicare Part D. That plan covers prescription drugs, albeit with copays that can add up to a lot of money. Medicare Advantage plans typically include drugs and other benefits but may limit your choice of providers. Medigap covers any provider covered by Medicare. AARP has an explainer you can find by searching “medigap vs. advantage.”
You don’t need an online account to get comparison information, but if you are signed-in, the website will save your information, making it easier to check for additional information later. Just click on “Health and Drug plans” at the top right of your screen to get started. To create an online account, go to medicare.gov, click on login and select create account. It will ask for your Medicare number and other personal information. Be sure you type in the right website to avoid the risk of fraud. If you don’t yet have a Medicare card, you can apply at the Social Security website, ssa.gov/medicare
First, it lets you pick the type of plan, starting with Medicare Advantage, Medicare drug plan or Medigap. And you can go back and check all three before deciding. Then it will break things down even further. Because I saved my information, the website knows the plans I currently have and lets me quickly compare them with other plans.
Unless you’re already familiar with the differences, I recommend you start by researching between Medigap and Medicare Advantage. With Medigap, you then have to choose between various options designated by letters such as A, B, C, etc. With Advantage, you’ll be asked to choose between HMO, PPO and prescription drug plans. You can go back and look at additional plan types to explore all your options.
Have your drug list handy
When it comes to basic health coverage, it asks very few questions, but for part D drug coverage or drug coverage on an Advantage plan, it needs to know what drugs you take. You may need to know the dosage strength (usually in mg or mcg) and quantity. It will use that information to show your total costs, including the cost of drugs. If you see a high total drug cost, scroll down to select “View drugs & their costs,” to see a breakdown of each drug and what it will cost at a local or mail-order pharmacy.
If a particular drug is expensive, compare it with a discount program such as GoodRX.com or Singlecare.com . The sites will give you the cost of each medication at local pharmacies. These programs can be much less expensive than Medicare or other insurance co-pays. I’ve used these sites and have gotten the discount price at my local pharmacy. The cost may not apply against your deductible, but you might save enough money to make it worth paying out-of-pocket. There are other drug discount programs , so it pays to do some research.
Double check with insurance companies
The Medicare website will give you links to the actual insurance companies, and I recommend you check any information with those companies either online or by phone. If you see a discrepancy between the company’s website and Medicare’s, call the company for an explanation. There may be a spousal or other discount you can apply.
There are also private insurance brokers who can help compare prices and allow you to purchase coverage directly. There are lots of choices, but as a SAG-AFTRA member, I have used ViaBenefits, which has a good online comparison tool and helpful support staff. Individuals can learn more at my.viabenefits.com. You can search without signing in or purchasing.
Although Medicare is a great program by U.S. standards, I personally wish it were less complicated. But it’s what we have, and thanks to an excellent website, it’s reasonably easy to make your best choices.
