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4 things to consider when choosing a Medicare plan

Medicare offers a lot of options, and it can be hard to decide which plans are best for you. No matter what your needs, there are four factors you should always consider when comparing Medicare plans.

1. Network

If you’ve ever been insured under an HMO or PPO plan, you may be familiar with the terms in-network and out-of-network. When a provider or hospital is in-network, you likely pay less for that visit. But it's important to realize that not every plan type relies on networks to determine cost:

  • Original Medicare (Parts A and B) and Medicare Supplement: These plans do not use networks or service areas, which means you can see any Medicare-approved doctor or visit any Medicare-approved hospital.
  • Medicare Advantage (Part C): These plans use provider networks. This means you must visit a doctor or hospital that is in-network to receive the greatest savings. 

Every private insurance company has different provider networks. When comparing plans, you’ll want to check if your doctors are in network. 

2. Prescription drugs

Many of us rely on maintenance medications to stay healthy. When comparing prescription drug coverage, it’s important to see if your medications are covered. A list of medications covered by a plan is called a formulary. You’ll want to be sure your medications are on this list. 

Once you know if your medications are covered, you’ll want to compare your costs for each. Some plans require copays (what you pay each time you fill a prescription), and others may have deductibles (amounts you must pay yearly before you receive a percentage off your cost). 

You’ll also want to check if there are quantity limits and requirements for which pharmacies you can use. Some plans limit your choice of pharmacy by geographic area; others require you to fill your prescriptions by mail either exclusively or after certain quantities of medication are filled. Different plans have different levels of coverage, so be sure to find the one that works best for you.

3. Travel

If you plan to travel often in retirement, it’s important to look at what your health care costs could be when out-of-state or out of the country:

  • Original Medicare and Medicare Supplement: With Original Medicare, including Medicare Supplement, you have the freedom to see any Medicare-approved doctor or visit any Medicare-approved hospital nationwide. Some plans offer coverage for foreign travel emergency care.
  • Medicare Advantage: You’ll want to choose a PPO plan if you travel often or spend an extended period of time outside the service area. PPO plans give you the freedom to see doctors and other health care providers outside your network using your out-of-network benefits. HMO plans only offer out-of-network coverage for emergencies.

4. Cost

Plan premiums may seem like the obvious bottom line when choosing a plan, but it’s important to look closely at the total value of a plan – not just the cost. In addition to the rates, you want to consider a few important questions when choosing a plan:

  • Do you get more for your dollar with one plan over another? 
  • Does the plan offer exclusive extras, such as fitness and discount programs? 
  • Are your out-of-pocket costs lower with one plan versus another? 

Everyone’s financial situation is different. Taking a look at the total picture can help you find the plan that best meets your needs now and in the future.

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Medicare offers a lot of options. As you begin to explore what's available, it can be hard to know which plans are right for you. When comparing plans, there are four factors you should consider to help narrow down your options. These are network, prescription drug coverage, travel, and cost.

 

First, let's look at network. Medicare Advantage plans use provider networks. This means you'll receive greater savings by visiting a doctor or hospital that is in your network. Original Medicare and Medicare Supplement don't use provider networks. With these plans, you can visit any Medicare-participating doctor or hospital nationwide, but it may end up costing more. As you compare, you'll want to consider if your doctors are in network and how important network savings are compared to the flexibility you may need in retirement.

Next, let's take a look at prescription drug benefits. Whether you're considering original Medicare plus Part D, or Medicare Advantage for your prescription drug coverage, you'll want to see if your medications are covered. Next, you'll want to compare what your costs will be for your medications under each plan. You'll also want to check if your plan has quantity limits and if there are requirements for which pharmacies you can use.

Now let's talk about travel. If you travel often, it's important to look at what your healthcare costs could be when out of state or out of the country. With original Medicare and Medicare Supplement, you can visit any Medicare participating doctor or hospital nationwide. Because Medicare Advantage plans use provider networks, you'll want to choose a PPO plan If you travel often outside your service area. PPO plans give you the freedom to see doctors outside your network using your out-of-network benefits. HMO plans don't offer out-of-network benefits except in emergencies.

Finally, let's talk about cost. While the plan premium may seem like the obvious bottom line when choosing a plan, it's important to look closely at the total value. For example, does the plan offer exclusive extras that you may be already paying for today, such as fitness memberships? And are your out-of-pocket costs like doctor visit copays or prescription costs lower with certain plans? This last one is especially important because it can be easy to go with the low number upfront, only to be surprised by higher cost down the line. Taking a close look at your total cost for common services can help you find the best plan for you now and in the future.

Whatever your needs, there's a Blue Medicare Plan for you. With a Blue Medicare Plan from Blue Cross NC, you can choose confidently knowing you're backed by the strength of our network and supported by local customer care specialists across our state. To learn more about Blue Medicare or to enroll, visit us at medicare.bluecrossnc.com.

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