How to Pick the Right Plan
Choosing the right Medicare plan can be complex and overwhelming, especially when there are so many options available. Medicare beneficiaries need to be aware of common pitfalls that can lead to unexpected expenses or limited access to necessary healthcare services. In this article, we review seven mistakes to avoid when selecting a Medicare plan and discuss reputable companies in the marketplace.
7 Critical Mistakes to Avoid When Selecting a Medicare Plan
1. Paying High Out-of-Pocket Fees
One of the most frequent mistakes is selecting a plan that results in high out-of-pocket expenses. Many Medicare plans have various deductibles, copayments and coinsurance costs that can add up quickly if you require ongoing treatments or expensive medications. When evaluating plans, it’s essential to carefully compare the monthly premiums and how much extra you might be responsible for throughout the year.
2. Plans with Limited Network Restrictions
Another common mistake is selecting a plan with a restricted network of healthcare providers. Many Medicare Advantage plans and supplemental policies enforce network limits, meaning that if your preferred doctor or hospital is not part of the plan’s network, you might either pay more for care or be denied service altogether. It is crucial to verify that your current providers are included in the plan’s network or that suitable alternatives are available nearby.
3. Choosing a Company with a Low CMS Star Rating
The Centers for Medicare & Medicaid Services (CMS) star ratings are a useful tool in assessing the quality and performance of Medicare plans. Choosing a plan from a company with a low CMS star rating can be a significant mistake because these ratings reflect how well a plan meets its patients’ needs and provides timely, effective care. A low rating may indicate issues such as customer service challenges, inaccurate claims processing or lower satisfaction scores among members.
4. Having Strict Prior Authorization Requirements
Many Medicare plans have prior authorization requirements for certain medications or treatments in order to control costs and ensure appropriate usage. However, if a plan is overly strict with these requirements, it can lead to delays in care, additional administrative burdens and unexpected disruptions in your treatment plan.
5. Plans with Geographic Limitations
Medicare plans can vary significantly based on geographic coverage, which can be a mistake if you have an active lifestyle or might relocate during the year. Some plans limit their coverage to specific regions or states and, if you plan to travel or relocate, you risk the possibility of losing access to critical services or having to navigate a new system of care that doesn’t meet your expectations.
6. Choosing a Plan with Mandatory Referrals for Specialists
Another pitfall is selecting a Medicare plan that requires mandatory referrals in order to see specialists. While this can sometimes streamline care and lead to better coordination among your doctors, it can also delay access to necessary specialized treatments. If you require regular consultations with various specialists, a plan that demands constant referrals can be cumbersome.
7. Having Limitations on Extra Benefits
Many Medicare plans advertise additional benefits such as dental, vision, hearing or wellness programs. However, some plans may have limitations that are not clearly outlined during initial marketing. These extra benefits might sound attractive, but if they come with significant restrictions, they can lead to disappointment in the long run.
Reputable Medicare Plan Providers
In addition to avoiding the mistakes outlined above, it is useful to know which companies offer robust Medicare plans. Here are some highly rated Medicare companies and what they provide.
Aetna
Aetna is known for offering a variety of Medicare Advantage plans with competitive benefits including low premiums and a range of extra services. Their plans often come with robust prescription drug coverage, preventive services and wellness programs. Aetna emphasizes streamlined member services and has a reputation for quality customer support.
Humana
Humana provides an extensive range of Medicare Advantage and supplemental plans geared toward varying healthcare needs. They often incorporate additional benefits like fitness programs, nutrition counseling and telehealth services. Humana’s plans are designed to be flexible, offering extensive networks that cater to the needs of many Medicare beneficiaries.
Cigna
Cigna’s Medicare plans are designed to offer value through a combination of cost-efficiency and comprehensive coverage. Their plans often include additional support services, such as care coordination and personalized health advice, and Cigna is recognized for its user-friendly online tools and resources that help members manage their care effectively.
Kaiser Permanente
Kaiser Permanente is renowned for its integrated care model, where the insurance provider works closely with a network of affiliated healthcare facilities and doctors. This integration ensures continuity of care and a smoother coordination of services. Kaiser’s Medicare plans often feature preventive care initiatives and comprehensive disease management programs.
Alignment Health
Alignment Health focuses on providing Medicare Advantage plans that offer a high level of personalized care. Their plans often place an emphasis on community health resources, ensuring members have access to not only medical care but also wellness support services. With a reputation for flexibility, Alignment Health designs its plans to cater to diverse healthcare needs.
Final Notes
When choosing a Medicare plan, it is essential to avoid common mistakes. By considering reputable providers like Aetna, Humana, Cigna, Kaiser Permanente and Alignment Health, you can weigh the extra benefits they offer and make an informed decision that secures your healthcare now and in the future.