Which Medicare providers can you see?
This is usually the most important question as people approach Medicare eligibility. There are two good reasons:
- You probably have doctors or hospitals you are comfortable with
- As you get older you will probably need more medical care
Here’s who you can see with each plan
|Original Medicare||Medicare Supplement<br />(or Medigap)||Medicare Advantage|
|With Original Medicare the answer is simple: any doctor or facility which accepts Medicare assignment. Just ask the provider or consult their website.||For Medicare Supplement (or Medigap) plans it’s the same. Since these plans just fill in the gaps in Traditional Medicare such as coinsurance (but not prescription drug coverage).||Medicare Advantage plans offer either PPO (preferred provider organization) or HMO (health maintenance organization) options. Both types of plans use provider networks to control costs. PPO plans allow you to see out-of-network providers but cover less for them. HMO plans provide no out-of-network coverage.|
This applies not only for doctors but also hospitals, skilled nursing facilities and other providers. Check to see if any you prefer (because of convenience or other preference) accept Medicare or are part of your network.
How much will you pay for coverage?
This can be a hard question to answer. The costs you need to know are:
- Premium: what your policy costs each month
- Deductible: what you pay out-of-pocket before coverage kicks in
- Copayments: what you pay for each visit to a provider
- Hospitalization: what you pay if you end up in the hospital
- Prescription drug costs: what you pay for your medications
- Maximum out-of-pocket (MOOP): the maximum you will spend in a given year
Your best option? Work with a local licensed advocate who can help you find the best coverage options for your situation. Everyone has different needs and financial limits.
At Connie Health we can help you optimize your Medicare coverage based on your needs and financial situation.
Are any additional Medicare benefits available?
Original Medicare (and Medigap) plans only cover hospitalization and physician services.
Many Medicare Advantage PPO and HMO plans in Maricopa County include additional benefits not covered by Original Medicare, such as:
- Gym memberships
- Over the counter health items
Look at which benefits you actually care about. Just because a benefit sounds good doesn’t mean it applies to your lifestyle. When evaluating additional benefits, be aware of how they are covered- only Medicare covered, routine or comprehensive.
Medicare covered dental, vision and hearing is typically covered when it involves a medical condition. Routine dental, vision and hearing are preventive services like exams and cleanings. Comprehensive benefits are typically an option to purchase a more inclusive benefit like crowns and extractions.
Connie Health can help you evaluate your situation and find the most cost-effective ways to get the additional benefits you need. The last thing you want is to pay for services which you won’t use.
You need someone to guide you through the maze of Medicare options.
That’s where we come in. At Connie Health, it is our job to help you cut through the fine print so you understand how each plan will affect your situation. With our assistance, you can choose a plan which is optimized for your health and your lifestyle.
The first step is to have a plan before you start looking at options.
Learn more about Medicare
Visit our Medicare Resource Center which provides helpful articles on everything you need to know about Medicare.