Every piece of the decision set out on its own, so you can settle one before you look at the next.
The shape of it
Almost every question people bring me sits inside one of these three ideas. Once the shape is clear, the rest stops feeling like alphabet soup.
The government program itself, split into a hospital side that covers inpatient stays and skilled nursing, and a medical side that covers office visits, labs, screenings and equipment. You can use it with almost any provider who takes it, and it leaves a share of each bill to you.
A private plan that delivers the same hospital and medical benefits in one package, usually with prescriptions folded in and often with extras attached. In exchange it works through a defined network of doctors and hospitals, and referrals or prior approvals can apply.
If you stay on the original route, you can add a supplement policy to absorb some of the costs it leaves open, and stand alone drug coverage for your prescriptions. If you take the bundled route, those pieces usually come built in, and a supplement policy is not something you can hold alongside it.
Piece by piece
Short descriptions to get your bearings. Send me the one you want to go deeper on and I will write back about your own situation.
This is the side that comes into play for an admitted stay, a stretch in a skilled nursing facility, or care at home after one. Most people pay nothing monthly for it because of the work history behind it, but there is still an amount you pay when a stay begins, and it resets under its own rules rather than on the calendar.
Doctor appointments, outpatient procedures, lab work, preventive screenings and durable equipment sit here. It carries a monthly premium, a yearly amount you cover first, and then a percentage of what remains, which is the part that catches people out when a treatment runs long.
Sold by private insurers to sit behind the original route and take on costs it leaves to you. These policies are standardized, so the same type buys the same benefits no matter whose name is on it, and the real differences come down to price, service and how the premium moves as you get older.
Every plan keeps its own list of covered medicines, sorts them into tiers, and works with its own set of pharmacies. Two plans with the same premium can treat your medicines completely differently, which is why I always ask for the list before saying anything useful about a drug plan.
There is what leaves your account monthly, what you hand over at the counter, and the amount you cover before coverage takes over. A low monthly figure can hide a heavy one elsewhere, so the only fair comparison is the whole year seen together with the care you actually expect to use.
Before the year turns, your plan mails a booklet listing what changes: the premium, the amounts you pay at each visit, the medicine list, the pharmacies and the providers in the network. Reading it is the whole job, because staying where you are is a decision the same as moving.
How it goes
There is no rush here. Each step waits until you are ready for the next one, and I am a message away at every point.
Your doctors, your medicine list and the dates that apply to you go in one place, so nothing lives on a scrap of paper.
Original Medicare, Advantage, Supplement and Part D each get their own look, measured against the list you saved.
Send a question about any plan detail and I answer in writing, so you can come back to it as often as you like.
Once the choice is settled, enrollment goes through Social Security or Medicare itself. I stay around for the yearly notice that follows.
How I compare things
A plan that suits your neighbour can be a poor fit for you, and it usually comes down to one of these.
If there is a specialist you trust or a clinic you have been going to for a long time, that gets checked against the network first. Everything else is easier to live with than losing a doctor who knows your history.
Names, strengths and how often. I run them against the covered list and the pharmacy tiers, because one missing medicine can outweigh every other advantage a plan appears to have.
Time spent away from home, a second address for part of the year, or family in another state all change which route makes sense. Networks care about geography in a way the original route mostly does not.
Not the ordinary year, the difficult one. I look at the ceiling on what you could be asked to pay, because that is the number that decides whether a plan protects you when something serious happens.
Save your doctors, your medicines and your dates, then send me the question that is holding everything else up. I will answer it in writing.
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