Seven Tips for Selecting a Health Plan
Tuesday November 9th, 2021
New to Medicare? Start here.
Unsure what your Medicare options are? Read this.
Selecting the right healthcare plan for your needs is an important decision just like selecting your PCP. In fact, the right plan can open the door to the right care for you. We’ve pulled together a list of things to consider when you’re deciding on a Medicare plan. Let’s dive into the differences between Original Medicare and Medicare Advantage.
Examine your health needs
- Do you have one or more chronic conditions? If so, you may want to consider a Medicare Advantage plan that could give you access to additional health coverage and benefits that could help you better manage your condition(s). Adding a value-based provider to your Medicare Advantage plan could give you even more support through on-site behavioral health and health coaching.
- How often will you need to go to the doctor? If you see your PCP regularly, you may want to select a Medicare Advantage that offers a $0 PCP copay. If you struggle getting to and from the doctor, look for a plan that offers transportation benefits. Some value-based providers offer transportation services as well.
- Are you anticipating any surgeries or procedures? You may want to opt for a Medicare Advantage plan that limits your out-of-pocket costs.
Figure out what you’re currently paying for health insurance premiums, copays, deductibles and out-of-pocket expenses including prescription drug costs and over-the-counter products and supplies. Are these costs affordable? If not, try to figure out what dollar amount would be more affordable. You may be eligible for additional government programs if you’re struggling to pay Medicare costs.
For example, if prescription drug costs are posing a problem, you may be eligible for Social Security’s Low-Income Subsidy or Extra Help program. A Medicare Advantage plan could also help with low-cost and zero-dollar premiums, reduced copays and limits on maximum out-of-pocket costs. Value-based care providers can also help you review your medications. They may help you find low-cost generics to help alleviate costs.
Determine the coverage you need
Whole-person health takes the whole person into account not just the body. Whole-person health considers your physical, mental and social needs to understand how they all work together. For example, when you have healthy eyes, you can maintain your independence and more easily perform daily tasks from reading to cooking to driving. A strong, full set of teeth gives you a great smile and helps you speak clearly and chew healthy foods. If you live with a chronic illness, medicines play a critical role in maintaining your health. Additional benefits like a monthly grocery or over-the-counter allowance could make it easier for you to get the nutrition and supplements you need for an active lifestyle.
That’s why it’s so important to select a health plan that takes the whole person into account: body, mind, eyes, mouth, prescriptions, environmental factors, everything that contributes to your overall health. A Medicare Advantage plan could help you get or stay healthier by treating your whole-person health needs with coverage the works for you, your needs, budget and lifestyle. A value-based care provider might be able to maximize the benefits of your health plan. They may offer on-site dental services, help you better manage your chronic illness through a combination of lifestyle adjustments and treatment options or assist you in getting access to outside services and support.
Think about your provider and facility choice
Original Medicare allows you the freedom to see any provider or facility enrolled in Medicare whereas a Medicare Advantage plan typically offers a network of providers. You’ll want to choose a plan that works for you and also gives you access to providers who can give you the right care for your needs.
At Humana, 67% of our Medicare Advantage members receive care from doctors who offer value-based care, which compensates doctors based on overall patient outcomes for the care provided rather than the number of visits, tests or procedures they perform.1 Our 2020 Value-based Care Report shows that Humana Medicare Advantage members with value-based providers receive more preventive screenings than those with non-value-based providers, which means issues can be detected earlier.1 The report also shows Humana value-based patients experienced 29.2% fewer hospital admissions and visited E.R.s 10.3% less, when compared to patients with Original Medicare.1
Review quality of care
Medicare Advantage plans are rated by the Centers for Medicare & Medicaid Services (CMS) to measure the quality of health plans. The more stars, the higher the plan rating. In 2020, 92% of Humana Medicare Advantage members were in 4-star and above quality plans.
Quality of care also applies to providers and hospitals in addition to plans. Learn more about PCP quality of care here. Humana’s Find a Doctor tool with Care HighlightTM ratings can help you find a doctor who meets your needs. Look for the green hearts and badges to find in-network doctors, including many providers that may meet care quality and cost-efficiency ratings. You may want to explore selecting a value-based care provider to address your health needs. Learn more about value-based care here.
Look at prescription drug needs
About 89% of adults aged 65 and older take prescription medicine, yet 76% think the cost is unreasonable. A Medicare Advantage plan with prescription drug coverage can help cover drug costs through preferred cost sharing at select pharmacies. A monthly over-the-counter allowance could help cover costs of medical supplies and equipment like a blood pressure monitor or fitness device. It’s important to also talk to your doctor about the different medications and quantities you’re taking. A value-based care provider may be able to help you reduce the amount of medication you’re on or help you manage those medicines more effectively.
Decide if travel is a factor
Original Medicare lets you see any doctor or facility enrolled in Medicare nationwide. If you travel frequently or split your time between multiple places throughout the year, you might want to consider a Medicare Advantage plan with a travel benefit like HumanaChoice PPO that offers in-network coverage across the nation.
Putting it all together
You have choices when it comes to your healthcare. You have the power to choose the right plan and the right provider for you. The more time and energy you spend thinking about your healthcare needs and wants up front, the better informed you’ll be when it comes time to select a Medicare plan and a provider. The good news is you don’t have to figure it out on your own. Medicare.gov is a great place to start learning. You might want to get in touch with a licensed sales insurance agent who can walk you through plans that could be a good fit for you.