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Choosing the Best Medicare Options for Your Situation and Needs

One of the most effective ways to go about choosing a Medicare plan is to start with a doctor or hospital that you like. Contact the business office for the provider or facility and explain that you’re about to choose a Medicare program—and ask them which they prefer. If they don’t participate in any Part C plan, you’ll need to consider using the more-expensive combination of traditional Medicare and a Supplement plan. If they express no preference, then ask for a list of the Medicare HMO/PPO networks in which they are members. That can be the basis of your “shopping list.”

In short, you want to find a Part C plan which includes your doctor and hospital as “network providers.” Network providers are the doctors and other health care professionals, medical groups, hospitals and other health care facilities that have agreed to accept the plan’s reimbursement payments and cost sharing as payment in full.

Generally, some of the best tips for shopping among Medicare and Medicare-related plans are based on the same rules that apply to shopping for standard individual or group health insurance:

  • the better your health, the more the flexibility offered by traditional Medicare plus a simple Medicare Supplement plan will work for you;
  • the worse your health, the more the cost-savings of a Part C managed-care plan become important;
  • traditional Medicare combined with a Supplement plan and Part D prescription drug coverage will cost you more each month in premiums and out-of-pocket costs but will give you more options in which doctor you see and what hospitals you use;
  • a Part C plan plus Part D drug coverage will tend to cost less in premiums and out-of-pocket costs but will restrict your options in terms of the doctors and hospitals you can use;
  • some Part C plans include prescription drug coverage, but it’s often a better idea to buy the drug coverage through a stand-alone Part D plan—that way, if you change your Part C coverage, your drug coverage won’t be affected.

One note: If you are a retiree of certain large corporations or a member (or former member) of certain labor unions, you may qualify for one or more custom Medicare-related plans designed for those groups. These types of coverage aren’t necessarily any “better” than standard Medicare-related plans—but they may involve lower out-of-pocket costs. The main thing to keep in mind, if you qualify for an employer- or union-based plan: If you transfer out of that plan and into standard Medicare-related coverage, you may not be able to transfer back.

Another important note: If you have limited income, you may qualify for a program that helps cover out-of-pockets expenses required by Medicare and Medicare-related plans. Finally, there are some resources available from the federal government. Everyone who uses Medicare or most Medicare-related plans receives a copy of the booklet Medicare & You each year in the fall. You can download the 2012 edition of the booklet from the Medicare website (www.medicare.gov) or order a printed copy by phone at 1.800.633.4227.