9 Questions to Ask When Evaluating Your Medicare Plan

By Jim Allsup

More than 45 million Americans are currently enrolled in Medicare and many of them are paying for a plan that is either too expensive or doesn't have the coverage they need. Each year, Medicare provides a window of opportunity for enrollees to reevaluate their healthcare coverage and to make any necessary changes or adjustments to their coverage. Each year that enrollment period starts on Nov. 15 and ends Dec. 31.

It is crucial that Medicare enrollees use this time to evaluate their coverage to ensure they are getting what they need at a price they can afford. Many people avoid this crucial step, fearing they will be unable to understand the legal and insurance industry jargon. Medicare plan selection services are available for these people. A Medicare plan selection service helps people find the best and most affordable Medicare plan based on their specific needs and circumstances. This service will help you evaluate your healthcare needs using expert knowledge of recent program changes and criteria that include the following 9 questions.

Do I need Medicare if I have private healthcare insurance?

You will use the same factors of cost and coverage when comparing private health insurance with Medicare. It is important that you speak with your private plan administrator before making any changes.

Should I use Traditional Medicare or a Medicare Advantage Plan?

A Medicare Advantage plan (Part C) is ideal if you require frequent doctor visits and take prescription drugs. If your current medical condition only requires that you make routine medical visits and take few or no prescriptions, traditional Medicare (Parts A and B) with a prescription drug plan (Part D) may be a better choice.

Does my current plan cover prescription drugs?

Traditional Medicare (Parts A and B) generally does not cover medications unless they're administered in a doctor's office or a hospital. If you require regular prescription medications, you will need to purchase a Part D plan for that coverage. If, however, you are enrolled in a Medicare Advantage plan, you may already receive prescription drug coverage.

How do I know if my prescription drugs are covered?

Every plan that offers prescription drug coverage has a list of covered medications called a formulary. This list can change each year, which makes it crucial that you or a professional Medicare plan selection service evaluate your coverage during the annual enrollment period. Failure to do so may cost you thousands of dollars in uncovered prescription medications.

What about gaps in coverage between different prescription medication plans?

For many individuals-whether in a Medicare Advantage plan with prescription drug coverage or a stand-alone prescription drug plan-there is a gap in coverage once they reach a certain out-of-pocket threshold. This is referred to as the donut hole.

A Medicare Advantage plan that offers prescription drug coverage provides a combination of services found in Parts A, B and D-your hospital, medical and prescription drug coverage. As far as traditional Medicare is concerned, the Part D coverage is separate-it can even have a separate deductible. So the rules Part D follows (including the donut hole) may be slightly different from the medical portion (Part B) of coverage.

For example, after your plan has paid a certain amount for your prescriptions, you will have to pay the full cost, up to $3,453.75 in 2009, before the plan will pay for your prescription costs again. That cost is prohibitive for many people on Medicare and makes the annual evaluation of your coverage much more important.

Can I keep seeing the same doctors?

Most doctors, hospitals, physical therapists and other healthcare providers accept traditional Medicare, which will allow you to continue seeing the same doctors if you choose to stick with traditional Medicare and a Part D plan. But, as with any other insurance, Medicare Advantage plans have a network of providers. If a doctor is outside that network, you may have to pay more. Before you join a Medicare plan, particularly a Medicare Advantage plan, you should determine if the doctors you see are part of that plan's network.

Will the plan cover dental and vision services?

Traditional Medicare does not cover dental, vision or health and wellness programs, but some Medicare Advantage plans do. To receive this type of coverage, you must evaluate the available Medicare Advantage plans for your needed dental and vision services. Again, the use of a Medicare plan selection service will provide further assurance that you will get the coverage you need.

>How much is it going to cost me?

Traditional Medicare premiums are relatively inexpensive, but your deductibles and copayments or coinsurance costs may be higher than what you would pay with a Medicare Advantage plan. Medicare Advantage plans may offer zero-dollar premiums and low copays. Some plans may even put a cap on total out-of-pocket costs. Your Medicare plan selection service can give you specific dollar amount and coverage information.

Will I be covered when traveling?

Traditional Medicare provides coverage throughout most of the country. Some Medicare Advantage plans are restricted to certain areas, but many offer out-of-network coverage in the event of an emergency while traveling. If you travel frequently or reside in different areas depending upon the time of year, it is important to find a Medicare Advantage plan that will provide coverage in both areas.

How do I know if I need a supplemental plan?

Traditional Medicare (Parts A and B) may not provide all of the coverage you require. Before paying for a supplemental plan, it is important to determine if you qualify for the Qualified Medicare Beneficiary program, have adequate coverage through an employer, or if you are already enrolled in a Medicare Advantage plan.

With medical costs skyrocketing and your own healthcare needs changing, it is imperative that you take advantage of the upcoming annual enrollment period offered by Medicare to determine whether you are receiving the coverage best suited to your needs and budget. This process is made easier with the professional expertise of independent Medicare plan selection services. Their knowledge and experience will ensure that you get exactly what you need at a price you can afford.