Joanne (00:00):
If you've decided that you want to enroll in a Medicare Advantage, which is also known as Part C as your choice of Medicare coverage, it can be daunting to figure out which plan, and which company to choose. So today we're going to talk about how you can confidently pick a Medicare Advantage plan to fit your needs during your transition to Medicare.
Cameron (00:18):
But before we start, my name is Cameron Giardini, and together my co-host Joanne Giardini-Russell and I operate Giardini Medicare, which is an independent insurance agency based out of Southeast Michigan. Although we are based in Michigan, we do work virtually over the phone to directly help consumers in about 13 different states find the right Medicare coverage for them. If we do not work in your state, we will connect you with another trusted independent agent that will be able to help you find the coverage that you want. Even if you choose not to work with us, we know that the information in today's podcast will help you have a successful and stress-free transition to Medicare.
Joanne (00:55):
So just want to start with a disclaimer. This is not an all-inclusive guide that will tell you exactly which Medicare Advantage plan will be right for you. Medicare Advantage plans, vary greatly from state to state and even county to county. It will be important that you speak to someone about your unique circumstances and your healthcare needs. Also, we're going to have a separate episode about how to choose a Medigap and a Part D coverage. So, we aren't saying you should only choose Medicare Advantage, but that is what this episode will be solely devoted to. If you have not already, we highly recommend that you listen to the in-depth Medicare Advantage podcast episode before listening to this one.
Cameron (01:30):
Yeah, Joanne brings up a good point there. Again, this is only focusing on how to choose Medicare Advantage. Of course, we can't make one episode without talking about the other one and people saying you “only favor one”. We are pro-Medigap, and we are pro-Medicare Advantage. So check out all of the episodes we have. With that out of the way, what is the first thing you should do when you're considering which Medicare Advantage plan to buy? In our opinion, the first thing you're going to want to do is to identify the plans that are in your area as well as get help from somebody that is knowledgeable about the subject, which of course we think is an independent broker like ourselves or somebody else in your area. Before you even reach out for help from somebody from an outside source, you can just go on Medicare.gov, the official government website for Medicare, and you can put your zip code into their Plan Finder tool.
Cameron (02:20):
This will allow you to see Medicare Advantage plans that are available in your area and then this will at least show you, “Well I know this company is in my area, this company's not”. It will just give you a better perspective when you see advertisements and other things of you know, what is available and what are the prices you are looking at in your zip code or your county or your state. And of course, you know from other episodes of ours, at Giardini Medicare, we always recommend you get customized advice from an independent insurance broker that is knowledgeable about the actual advantage plans in your specific area. We're not saying any independent agent's going to be a “go-to”, you shouldn't just talk to anybody. But again, use the knowledge from the plans that you have seen on Plan Finder that are available and ask people and say, “Hey, are you licensed? Or do you sell these plans?” If they only do a small handful of the plans in your area, they might not be right for you. Just compare a couple of agents and what they offer. You're really not comparing prices, everyone's offering the same price. You just want to figure out who seems to have good knowledge of the local options that are available to you and how many plans they can offer in your area.
Joanne (03:29):
And just another couple of tips, when Cameron mentioned a few agents don't check 10 agents, because at the end of the day everyone's likely offering the same coverage, the same price, and things like that. But find a few people you can connect with. Then the other two or three exactly, but not 10 or 12, and make yourself crazy. But also, there are ship counselors, they're called different things in different states, but they are ship counselors, which is a funded volunteer position funded by the government and they can also help with a lot of the comparison tools if you prefer doing something like that.
Cameron (03:58):
Yeah, if you don't trust any agency or if you want no one making any commission, you can always reach out to SHIP just as another source of advice or as a sounding board. And, then again, once you've done that, once you've familiarized yourself with the different plans, I'll have Joanne talk about some of the details you might want to consider first when looking at Medicare Advantage plans,
Joanne (04:18):
Right? So, when Cameron says you go to Plan Finder first, now you're going to have to start the whole sorting mechanism basically. Medicare Advantage plans have a lot of different coverages and benefits. So, before you're looking at all these plans, just make a quick note of things. Literally, take a list and start a list saying, what's important to you? So, we're going to talk about a lot of these features and then even at the end of an episode like this, you can get your list out and say, well that was important to me. We even kind of have a ranking system internally like, you know, hey, tell us is dental, your end all be all, or is keeping your orthopedic surgeon your all be all? So, we're going to walk you through those types of things, but here are some coverage details that you're going to want to consider.
Joanne (04:56):
Things like an HMO versus a PPO. What do you feel more comfortable with? How about the provider networks? How about prescription costs? Those are a really important feature right there and the coverage of those prescriptions. How about medical out-of-pocket costs? Are you using your plan a lot? Is that a super important thing to you? Or just kind of a background thing? Then again, we're going to talk in more detail about this, but it's the extra benefits that you're all hearing about and seeing on TV. Those have become a good part of these plans. So, decide if that's your end all be all, but we're going to dive into those topics one by one as we go through this episode.
Cameron (05:31):
Yeah, now that you have that mental list in your mind of what might already be a little bit more important to you versus some of the other things Joanne just mentioned, we will dive into more detail for each. One of the things you'll want to consider is doing you prefer an HMO, which is a health maintenance organization, or a PPO, which is a preferred provider organization. Determine which one you prefer and whether you are open to both. You don't have to pick one or the other, but some people are more inclined to go with an HMO versus a PPO and vice versa. HMOs, typically do have lower out-of-pocket costs, but they are more likely to require referrals to a specialist compared to PPOs and they will limit your out-of-network coverage most likely only in the event of an emergency.
Cameron (06:18):
Whereas PPOs on the other hand, you may have higher out-of-pocket cost potentials, but you are unlikely to need referrals to see specialists and it will give you the flexibility to possibly go outside of your plan's network even in non-emergency situations. Now, we've talked about this more in our in-depth Medicare Advantage episode, but there is also a misconception out there that PPO plans don't involve managed care or prior authorization, but that is simply not the case. They may have more flexibility to go in or out of the plan's network, but both types of plans at the end of the day are managed care alternatives to original Medicare. So, whatever one you pick, the insurance company will still be able to dictate what services you may or may not be able to get through prior authorization and other methods. So, along the lines of whether you want to go in or out of network or have that potential flexibility, Joanne can talk about the actual provider network itself when it comes to Medicare Advantage.
Joanne (07:16):
Medicare Advantage plans, remember that they're offered by private insurance companies, and they are, as Cameron just mentioned, an alternative to Original Medicare. So, it's important that you take into consideration the provider network of that insurance company that's offering that Advantage plan. Now, networks are likely not the same. And this is something that is important to understand as the insurance that you were on potentially with an employer plan or an under 65 plan. So, we get a fair amount of people coming into Medicare that says, “Well, I'll just take the ABC insurance company because I had them at work and my doctor took it and the hospital was great, and everything worked out great.” Well, that doesn't mean it's going to carry over into the Medicare space, and in fact, it often does not. They are very, very different things.
Cameron (07:58):
That's huge to mention because that does happen often when people get used to the network and think it carries over to Medicare.
Joanne (08:04):
So, we're going to basically clear the slate, you're starting over. That's why networks are important. Every advantage plan, even within the same company sometimes can have a different network. So, here are some things to consider when you're looking at Medicare Advantage plan networks. You're going to be looking at DME, which is durable medical equipment. They actually have their own networks. How about home health coverage? I mean that has a network itself. Hospitals have a network. So, do you want to use multiple hospital systems? Are you okay to use one or a couple in your local area, things like that? But everything is confined to a network. And then the biggest thing that people typically are looking at is the doctor network. So, you need to determine if the plan is more important to you than potentially certain doctors. Let's say you have eight doctors, and you know, six of your doctors fit this plan and your two most important doctors do not accept that plan.
Joanne (08:58):
Is that a good plan for you? Is that going to be a good fit? So, it might be possible to fit everybody, in there. You might have eight doctors out of eight doctors, but you must think about these things ahead of time because you can't just change these plans mid-year, which we'll talk about in a little bit. Also, beyond those types of networks which are a little bit more immediate in terms of your everyday life, now what about travel? What if you're a snowbird, which is very common in Michigan? We have snowbirds that spend five months down in Florida and the rest of the time here in Michigan. So if you're doing that, what kind of network situation, what kind of doctoring situation are you in? You might want to consider plans that have a more national network, or a strong regional network of providers. So, these are things to try and plan if possible.
Cameron (09:46):
Yeah, and I want to highlight something that Joanne talked about. Just figuring out these networks is super important. It's probably one of the biggest things people must consider for a specific Medicare Advantage plan. And you may come to the realization that you know, if you have a long list of specialists (maybe you have 8, 9, 10 specialists), whatever it might be, it's very possible there are no plans out there that cover every single one of your doctors and it may come down to where you have to figure out which one you're willing to part with if you truly want the Medicare advantage plan that you're choosing to enroll in. Now, moving away from networks, HMOs, and PPOs, we'll talk about whether you want to consider prescription coverage and costs when it comes to Medicare Advantage plans. Again, Medicare Advantage plans are bundled plans.
Cameron (10:30):
This means that the medical and prescription coverage, it's all tied together in one package. So, make sure the Medicare Advantage plan you are choosing also covers the prescriptions you take on a regular basis. Again, you want to make this whole plan fit your needs and you don't want to just look at medical costs or just the flashy extra benefits that we'll get to in a bit. Also, you cannot pick and choose, you can't pick a plan that covers your medical and then pick a different prescription plan to go with it. You really want to make that whole package work for you. And then like prescription costs, you're going to want to think of your medical out-of-pocket cost and needs. Think about the treatments that you're most likely to need in an upcoming year and find a plan that limits those out-of-pocket costs as best as possible.
Cameron (11:14):
For example, if you see a specialist a couple of times per month, that copay for a specialist is probably going to be much more important to you than to other people with fewer specialist visits or people that really don't even go to the doctor at all. Or maybe you have upcoming surgeries you've been holding off like cataracts or knee replacements, you might need physical therapy on an ongoing basis. And there are just additional things to think about. You might be concerned with hospitalization costs or max out of pocket. Maybe you want alternative treatments like chiropractic or acupuncture, all of those medical needs, you can rank them, you can think about all of them, just a couple. But just keep in mind that all plans will have different costs and coverage for those. So you'll want to compare those options for whatever's important to you. And then Joanne can talk about going away from the core of every plan with the medical and the prescription coverage and flip over to extra benefits, which is what everyone wants to know about
Joanne (12:07):
The TV stuff. <laugh>. Now, this is the stuff you hear Joe Namath talk about on TV and this is what you're probably seeing postcards and advertisements about. So, these are the extra benefit. What always pops into my mind is “get all the extra benefits that you deserve”. That's talking beyond some of the things we're going to be talking about here, but let's talk about the reality of these extra benefits. One of the biggest reasons that the Medicare Advantage plans themselves have increased in popularity is exactly because of these extra benefits they can offer things that are not covered by Original Medicare. Insurance Carriers, they're allowed to put these extra benefits in and they're very heavily advertised but look at them, some of them are really good, some are a little bit of fluff in my opinion, but find out which ones are really important to you.
Joanne (12:49):
There are some good solid pieces here, such as routine dental, vision, and hearing. Some plans may only cover low-cost routine services like exams or cleanings and some x-rays, but others could possibly cover thousands of dollars worth of routine, routine dental care. Also, when you're looking at dental, look at your carrier to see if there's a dental buy-up option. Maybe another $20, $25/month you could add a significant amount of dental, which I think is usually a good idea if you're going to tack that on. That can be a solid piece, or it could be a marginal piece. But again, go back to your Wishlist, and if dental is number one on your list, make sure you're getting some solid dental from your particular plan. Another thing that's very popular with people is gym memberships. Now, most Medicare Advantage plans do offer a no-cost gym membership, but you just want to make sure that your exact gym is going to fit into that because you don't want to sign up for the plan because it has a gym membership and realize that your facility doesn't work with that plan.
Joanne (13:49):
There's also a lot of razzle-dazzle about the OTC benefits. It's over-the-counter benefits and some groceries. Many of these plans are now offering even more and more as time goes on, they're offering allowances for over-the-counter items, which are, band-aids, cough syrup, vitamins, and things like that. But that allowance limit is going to vary by plan. Some of them will carry over quarter by quarter, some will not. It's usually use it or lose it. You just must understand all those features. Some are even covering groceries these days, but again, this is what you're seeing on tv. Recently told me it was $50 a quarter for the groceries or $50 a month, I can't remember which. But again, not all of these extra benefits that are available are going to be available in any plan.
Joanne (14:35):
Those are the most common benefits that people are kind of after. But you really must drill into the details of those extra benefits. But again, we're going to repeat here to not get too caught up in the hype of all those benefits that are on the national commercials. You know, again saying you're eligible for all this money back and things like that. Talk to your local broker, talk about which of those benefits are really important to you, and then take that into consideration when you're buying and choosing that overall plan for yourself.
Cameron (15:03):
Yeah, exactly. So, I just want to overview that as well and just say, yes, these benefits exist. You know, there's not a catch to it. It's very common for most plans to provide dental, vision, gym memberships, and everything Joanne talked about. So make sure that the networks fit your needs and the benefits that you're getting are actually what you think that they should be and you're not just getting sold something you can't actually use. Now that we've talked about basically an overview of all the different things you might want to have on your Medicare Advantage Wishlist, let's actually just dive into the process of narrowing down your Medicare Advantage options from dozens to maybe a couple that might work for you. Keep in mind that Medicare Advantage plans, again, bundle all these benefits in one package. So you're going to want to make sure the plan as a whole fits your needs to the best of your abilities versus just picking one based on one small detail that we talked about.
Cameron (15:58):
The first thing we really recommend is you want to go and do an analysis based on your prescriptions. And this is actually done again through medicare.gov on the Plan Finder tool. This will help you narrow down dozens of plan options into just a small handful based on which ones seem to cover your prescriptions at the lowest possible out-of-pocket cost. Now, this is going to vary based on if you have a lot of meds or a small number of medications. If you have a bunch of medications, you might be limited to just a couple of plans that really cover them well. Whereas if you just take a couple of generic medications, this really might not narrow down your plan options as much as somebody else. After that, you'll want to check to see if plans that cover your prescriptions will also work for your medical providers and the hospitals that you use. So, what I mean by this, going back to the networks is you want to make sure that the plan that fits your prescriptions also has your doctors and providers in the plan's network.
Joanne (16:58):
Typically, let's point out too here, Cameron, that that's not done in medicare.gov, that's in a carrier tool. So if you're looking at these and like Cameron said, you've narrowed it down to six plans out the gate that work really well with your medications and you see that Aetna's one of those plans, then you're going to have to go to an Aetna site and go to a find a doctor tool. So there's a little bit of work involved in finding these, but this is really how you need to do this so that everything kind of works for you so that you're not surprised after you get into the plan. I just don't want you to look in medicare.gov for the tool to find the doctors and hospitals for Medicare Advantage.
Cameron (17:34):
Yeah, that's a really good point to bring up. That's exactly why we say that you should work with an independent Medicare broker because that's really our job. You know, we're here to compare all of the plan options, figure out all the plan networks, and see which fits your network of providers. So of course you can do it on your own, but that is something where we can help you at least narrow it down without you having to go to each website. Then at this point, once you've narrowed it down based on prescriptions and providers, the next thing you'll probably want to check out is the monthly premiums and the medical out-of-pocket cost for the procedures that are most important to you. So remember, Medicare Advantage plans, are funded by the federal government as we talked about in our Medicare Advantage episode.
Cameron (18:18):
It's very likely you will find a plan with zero monthly premium. Don't think that paying more for coverage is going to get you something better and don't be too thrown off by something that says at zero premium. And then lastly, what you'll want to do is take into consideration all the extra benefits we talked about. You know, maybe dental is very important and you have a dental implant you need to be done that is something you might want to prioritize. Maybe you have a gym membership that's expensive and you really like to use it and that's something you want to check on. Basically, just figure out which extra benefit is most important to you and start narrowing down the list of whatever plan remains just know that this is the normal order we suggest choosing a plan if you have extra benefits that are really, important to you.
Cameron (19:02):
Of course, you can start with that. Maybe prescriptions are most important or maybe you have surgery upcoming. You can start with whatever you want in this process. Again, we typically start with prescriptions and go from there. But if you have a doctor you're not willing to lose, you might want to just figure out which plans include that doctor first. So, keep in mind this is all flexible and of course, you can talk to a broker to figure out which option is going to be right for you. Then once you find a plan and choose a plan, enroll with a broker. There's no benefit to calling the company directly as you're going to get the same exact plan, whether you call the insurance company directly or if you enroll with a broker and at least with a broker, you get our support and customer service at no added cost. So I'll have Joanne talk about this, but what happens if you want to change in the future? Is this a permanent decision?
Joanne (19:53):
Well, the first thing to understand is that Medicare Advantage plans are annual contracts. So, you're not likely to pick this for your lifetime. You're not, period. Make sure you find a plan that fits your needs for this year and make sure you're okay with the worst-case scenario with your plan, just in case. So we can only make decisions with the information we have currently and you can't predict the future, it is very possible that there are a few options you would be okay choosing. So, don't worry about the perfect choice, which again goes back to if you know five of your doctors take three different plans and you compare them, nothing again has to be perfect, because you're never going to be perfect with these plans, but you can change it next year. We do want you to review those plans every single year. Especially think about this too, as you're coming into Medicare. If you're coming into Medicare in September, you might only be in this plan from September till December 31st. And if you decide you didn't like it in the first few months, then choose a different Medicare Advantage plan for the next January.
Cameron (20:51):
Yeah, of course, don't just pick any plan based on the thought that you're going to change, but do everything to the best of your ability based on what we talked about. If you must make a change, understand it's not that difficult. There are no longer health exclusions to make a change as we talked about in other episodes. So just keep that in mind when you go forward. Of course, the time to change plans if you're wondering is the Annual Election Period, which goes from October 15th until December 7th of every year. And if you make a change during that time, your new plan would be in effect on January 1st of the following year. Medicare Advantage plans do seem to have a lot of moving parts and while this is true, there is a method to the madness. You can take simple steps like the ones that we talked about in this episode to make sure you are enrolling in a plan that fits what you need as well as what you want.
Cameron (21:39):
It is always important to consider Medicare Advantage plans as a whole, so that way you don't enroll in the wrong coverage just due to a short-term flashy benefit. As always, please leave us a review on your podcast app and subscribe so you can listen to future episodes. You can also find more Medicare content from us by going to YouTube and searching Giardini Medicare. If you want to schedule a one-on-one phone call with one of our licensed brokers, you can schedule online at gmedicareteam.com or call us at (248) 871-7756. And last but not least, if you want to ask us any questions or give us any feedback, you can send us an email at info@gmedicareteam.com. Thanks for listening and have a good day.