How To Get The Most Out Of Your MyMedicare Account
President/CEO at Healthcare Solutions Direct, LLC, a nationwide insurance agency focused primarily on the retiree health market.
When you are eligible for Medicare, access to healthcare changes greatly based on where you live. Living in the city can mean having a wider variety of options when selecting your Medicare plan. However, in rural areas where the population is more spread out, you might not have the same healthcare options.
If you live in an urban center, more medical professionals and more competition could also mean more options when it comes to Medicare Advantage plans. Advantage plans, which have become popular, operate differently from the federal government’s Medicare Part A and Part B. Medicare Advantage plans are required to offer at least the same benefits as Medicare Part A and Part B but are offered by Medicare-approved private insurance companies.
The appeal of Medicare Advantage plans is they often include prescription drug coverage, which would need to be purchased separately as a standalone Part D for those keeping traditional Medicare Parts A and B. In exchange for some of these additional benefits, participants in a Medicare Advantage plan may be required to only see providers within the network to keep costs low. If you went out of network for care, the bill could be significantly higher.
In cities, this typically is not as big of an issue, but in rural areas that offer fewer choices, you could struggle to keep all your care within the Medicare Advantage plan’s network. With fewer doctor’s offices and specialists within easy driving distance of sparsely populated areas, this type of Medicare coverage needs to be carefully reviewed to make sure it fits your needs. There are regional PPO plans that may offer a larger network but fewer benefits to offset the cost. Unfortunately, in my experience, most areas offer few regional PPO plans to choose from when looking into Medicare Advantage plans.
Although there has been increased interest recently in Medicare Advantage plans for many new beneficiaries, what seems great on paper may be harder to fully take advantage of if you live in a rural area. A recent study in Health Affairs noted higher levels of dissatisfaction in Medicare Advantage plans for those living in rural areas. This is because such areas offer fewer benefits and narrower provider networks. However, that limitation is not always clearly presented to Medicare beneficiaries when they are considering plan options. With access to care being a top priority for medical insurance, along with price, the logistical challenges of having a Medicare Advantage plan outside an urban area can outweigh its additional benefits.
For this reason, the study noted that compared to urban areas, more Medicare beneficiaries in rural areas who initially enrolled in Medicare Advantage plans ultimately wanted to switch back to traditional Medicare Parts A and B. Although purchasing a standalone prescription Part D drug plan would not be an issue, trying to enroll in Medicare supplemental coverage, known as Medigap, may be an issue. This is because outside the Initial Enrollment Period (IEP) for Part B, which lasts seven months, you may need to answer medical questions to purchase this type of supplemental coverage.
Potential solutions include looking into Medigap supplemental coverage when you first enroll into Medicare during your IEP. During this time, an individual is typically guaranteed coverage and does not need to medically qualify to purchase supplemental coverage. Another possible solution would be to review the regional PPO Medicare Advantage plans offered in your area.
Even though Medicare Advantage plans may look more appealing, if the providers you need are not in your area, your benefits could go unused, and you could end up paying more. In that case, traditional Medicare Part A and B may work better for you along with a Medigap supplement plan. That is why you should take into consideration where you live in addition to your specific health needs when picking the right plan for you. A qualified Medicare insurance agent can help you make that assessment. Whichever direction you decide to go, get all the facts first, and consider what your healthcare needs may be in the future.
The information provided here is not investment, tax or financial advice. You should consult with a licensed professional for advice concerning your specific situation.