by Joseph Doratan

I often encounter people asking me to recommend the best Medicare plan. I am a straight shooter; I’ll tell you this: there is no perfect plan. Every plan has its limitations, exclusions and nuances in benefits. When I say benefits, I am not referring only to co-pays or the financial responsibilities.

There are other significant values beyond the monetary sense. For example, can you see any doctor who accepts Medicare? Do you have the freedom to see your doctor without referral? Or you have to go through your Primary Care Physician (PCP)?

If your plan is HMO, is your PCP in the network? How about the specialists you want to keep, are they in the same medical group as your PCP? There might be certain medical groups that you’d like to be able to access. Are they even contracted with the Medicare plan? Remember that when you use an HMO, if you use a doctor or provider without referral and outside of the network, you will be financially responsible for the medical costs 100%.

Another important consideration is the hospital. For emergency cases, you can go to any hospital. When you use 911, normally you’d be sent to the nearest hospital. Question is after you are stabilized, where would you be transferred to? What are the hospitals that your PCP has visiting rights to?

Plans also differ by the set of formulary they carry. You want all your medications to be covered. If not, you might need to pay much more. So, whether your plan covers all your medications or not need to be checked.

Other benefits that will make you prefer one plan over other plans would be worldwide coverage. People who travel abroad do not expect to get sick but they can. Does your plan cover that? How about gym membership? Transportation, chiro, acupuncture, over-the-counter drug? Have you heard of hearing aid allowance? How about dental? How much are the monthly premiums and the co-pays to have root canal, crowns or even dentures done?

Medicare plans also have Star ratings. These are rated by CMS, the Federal agency running the Medicare program. The ratings are correlated to the member satisfaction and quality of care. Again, this is a huge significant value beyond what you see in dollar amounts in the Summary of Benefit of your Medicare plan.

I suggest that you go through your Annual Notice of Change (ANOC) sent to you by your Medicare plan at the very least to be aware of the benefit changes in the upcoming year. Annual Election Period starts on October 15 and ends on December 7. If you are planning to review and make changes, do so, otherwise you’d be locked in for another year, unless you have other qualifying conditions that will allow you to switch beyond December 7.

If you need my help reviewing, please call 855-955-1800.