Choosing a health plan in retirement isn’t something to rush through. It can be tempting to stick with what you have or pick the first plan that looks affordable, but this decision can greatly impact your health, budget, and even your peace of mind for years to come.
Before getting started, this is also the point where many people ask, “Why do I need a broker?” However, the truth is, a good Medicare broker can help you compare options, understand the fine print, and avoid costly mistakes you might not see coming.
- Have an Idea of Your Current and Future Health Needs
The starting point before selecting any plans is to understand your own health situation.
If you are relatively healthy, it’s easy to think you don’t need much and choose the cheapest plan. However, remember that health can change quickly, especially as we age. Chronic conditions can develop, new prescriptions can be added, and you may need to see specialists or have procedures that you didn’t anticipate.
Look back at the care you’ve received. How often do you see your primary care doctor or specialists? Have you had any new prescriptions or unexpected hospital visits? Or maybe your doctors are recommending hip replacement surgery soon?
If you know your health will require more attention, choosing a plan with better coverage, even if the monthly premium is a bit higher, may save you more money in the long run.
- Don’t Only Consider the Premiums
The monthly cost is a major factor, but premiums are just one piece of the puzzle.
A low-premium plan can cost more if it has high copays, coinsurance, or deductibles. Those costs add up quickly if you have frequent appointments or need multiple services and treatments.
Look closely at how much you need to pay before the plan starts covering services. Think about whether there are any copays or coinsurance for the doctor visits or lab work you’ll get done. Additionally, be wary of how high out-of-pocket maximums can be.
The goal is to balance what you can comfortably dish out each month with what you might need to pay if you have a bad health year. Plan for the “what-ifs” as much as the “right now.”
- Know the Difference
One of the most critical decisions is whether to get coverage through a Medicare Advantage plan or keep Original Medicare and pair it with a Medigap (Medicare Supplement) plan.
Medicare Advantage plans usually include drug coverage. Being enrolled in an Advantage plan means the private insurance carrier now manages your Medicare benefits. They often have lower premiums and work with provider networks, but require copays or coinsurance for most services.
Medigap plans work with Original Medicare and pay secondary to cover some or all the costs that Medicare leaves behind. They generally have higher monthly premiums than Advantage plans but fewer out-of-pocket costs when you receive care, and you can see any provider nationwide who accepts Medicare.
The right choice depends on your budget, health needs, travel habits, and how much flexibility you have in choosing providers.
- What About Prescriptions?
Prescription drugs can be one of the most significant ongoing expenses that retirees face. Even if you take no prescriptions or your current medications are affordable, a health change or plan change could raise your costs significantly.
If you’re on Medicare, drug coverage comes through either a standalone Part D plan or drug coverage built into a Medicare Advantage plan.
Each plan has its own formulary (list of covered drugs), and each drug is placed into a tier that determines how much you pay.
When comparing plans, ensure all your prescriptions are covered and check the tier level for each medication. Even a slight change in drug coverage can make a difference in your yearly costs.
- Does Your Doctor Accept Your Plan?
If you have a favorite doctor or a specialist you trust, do you know if they accept Medicare or your specific Medicare Advantage plan?
Don’t rely on memory or assumptions. Doctors sometimes leave networks mid-year, and hospitals may be covered under one plan but not another. Although it is not as common, some providers don’t accept Original Medicare or aren’t taking new patients.
Always confirm directly with the providers and check the plan’s provider directory.
- Extra Benefits
Many Medicare Advantage plans offer extra benefits like dental, vision, hearing aids, fitness memberships, and even grocery or over-the-counter cards. These can be valuable, but they shouldn’t be the main reason you choose a plan.
It’s better to make sure the plan meets your core health and financial needs first. Then, if two options are equally good in those areas, the extra perks can be the deciding factor.
- Consider Your Personal Lifestyle
If you spend part of the year in another state, travel often, or live in an area where you regularly cross state lines for care, your plan choice matters even more. You want to be sure your plan reflects the ease of healthcare access and simple coverage you desire when needing care without costing an arm and a leg.
- When Can I Enroll?
Even if you find a better plan in February, you might have to wait until the next enrollment period to make a change.
Remember these windows:
- Annual Election Period (AEP) (Oct. 15 – Dec. 7) – This period allows you to make changes to your Medicare Advantage or Part D plans.
- Medicare Advantage Open Enrollment Period (MAOEP) (Jan. 1 – Mar. 31) – If you’re enrolled in an Advantage plan, you can make a one-time change and enroll in another Advantage plan or return to Original Medicare.
- Special Enrollment Period (SEP) – These windows are triggered by life events like moving, losing coverage, or qualifying for specific programs.
As for Medigap plans, you can apply to change to another Medigap plan at any time, but you can be subject to health questions in most states before getting approved, unless there is an underwriting exception that applies to you and your situation.
Knowing these timelines can prevent you from getting stuck in a plan that’s not right for you.
- Seek Help
The good news is you don’t have to figure this out alone. Licensed Medicare brokers can compare plans, explain your options, and help you understand all the ins and outs.
Whether you are new to Medicare, changing after several years, or doing your annual review, having an expert in your corner will save you time, stress, and money.
- Get Started
Choosing your next health plan affects your finances, access to care, and overall quality of life.
The key is approaching the process with your current and future needs in mind. Plans change, and health changes. Taking the time to do some research and consider expert guidance will ensure you pick a plan that has you covered, no matter what circumstances lie ahead.
