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Other than the premium, there are several important items that we look at when choosing a plan. Make sure you find out the answers to these questions before signing up with any plan.
Medication
How much is it going to cost me and does the plan include what I'm taking in its formulary? If you are on a maintenance medication that you take every day or so you must find out the following:
Is there a deductible?
After I pay the deductible how much will my medication cost every month? Don't take the stock answer "your generic drugs are $5 and your brand name drugs are $30". If your generic drug is a "non-preferred generic" you will be paying the Tier 3 rates of $50 to $80 per month.
If I go into the "Donut Hole", when will that happen and how much is my medication then?
When do I come out of the "Donut Hole" and how much will my medication be then?
Would it be better to get a stand-alone Part D plan along with a Medicare Advantage plan or supplement without Part D coverage - or get it all in one integrated Medicare Advantage plan? A good agent can compare different plans to find out! By doing an analysis of your medication we can save you thousands of dollars in co-pays over 1 year.
The Plan
You have options. You can purchase a Medicare Supplement, which is usually the more costly option. You can purchase a Medicare Advantage HMO plan, a Medicare Advantage PPO plan, or a Medicare Advantage PFFS plan. Other options are a SNP, MSA, Dual, Cost, and PACE. Which is right for you? There is no way to tell on a website, each person's situation is different. You may have a different plan than your spouse does. We'll sit down with you (and your spouse) and compare all your options.
Hospital Inpatient Co-pay
How much do I have to pay if I go into the hospital? Does the plan have flat co-pays, maybe $0 - $500, even if I stay there 10 days or do I have to pay $200 or more per day? How much do I have to pay before reaching the maximum out-of-pocket cap?
Skilled Nursing
If I need skilled nursing, how much do I have to pay and does the plan have a 3 day hospital stay requirement before receiving these benefits?
The Doctor
Does my doctor accept the plan, how large is the network and do I need a referral from my primary care doctor to see specialists? You also need to look to see how much the other co-pays are although the difference between a $10 doctor co-pay and a $15 doctor co-pay is small. If an annual physical is important make sure you get on a plan that covers physicals.
The Agent
Will your agent take the time to compare all available plans for you and get you the answers to the above questions so you can make an informed choice? Or does s/he try to fit you into a plan. |
