What will you pay in copays and other cost shares?
This is the sixth in this series. To start at the beginning, go to 5 Questions to Ask Before Enrolling.
Your decision will be easier to make if you first estimate how often you will see doctors and other medical professionals in the next year. Use that information to determine how much you are likely to pay in copays and other cost shares both in a most likely scenario and in a catastrophic scenario.
To do that you will need to know what your copays, coinsurance and deductible will be for the services you are likely to need.
To see what portion of covered medical expenses you will be responsible for, view the Summary of Benefits or Evidence of Coverage for the plans you are interested in. You can get these documents from the companies’ websites or from your agent. These documents will outline in detail what you will pay in copays and other cost shares for doctor visits and other services.
To see which plans are worth investigating, refer to the list you created when answering question 2. The best Medicare Advantage plan for you is probably the first one or second on the list so long as it covers your medicines and medical providers.
If you think your monthly copayments will be over $100, a Medicare Supplement Plan is probably a safer option.
If your total cost shares are only $100 a month a Medicare Advantage Plan may still be a good idea. However, may have medical expenses beyond what you anticipate. If you need to see non-network specialist multiple times or have a hospital stay, one of the more comprehensive Medicare Supplement Plans may be a better choice than a Medicare Advantage Plan.
Medicare Supplement Plans
If you are considering a Medicare Supplement plan, you can see an overview of how these plans cover different medical services here Medicare.gov. (Look for the links for your state if you live in Massachusetts, Minnesota or Wisconsin. The other states use the same plan designs.)
For more than an overview of the Medicare Supplement Plans available in your area click here. Then:
- Enter your zip code
- Click the “Continue” button.
On the next page, you will see a table that will make shopping for a plan easy. Write down the price range for any plan you are interested in. You will find the price range under “Monthly Premium” in the left column. Then click “view all benefits” for the plan. The table will show you what your copay or other cost share will be for doctor visits, hospital stays, lab services and other services.
If you like a plan, all you need to do now is to find the company that has the lowest premium for it. The plans are standardized, so no company that offers Plan F, for example, has better benefits than any other carrier offering the same plan.
Near the top of the table, click the link “Companies offering this Policy.” This will give you a list of the companies offering the plan you like. You will also see the phone number and website for each company. Just call or click to discover which one has the lowest price.
If you decide to purchase a Medicare Supplement Plan, you will probably also need a Prescription Drug Plan, since no currently sold Medicare Supplement Plan covers prescriptions. Use the steps outlined in Question 2 Are your prescriptions on the formulary (list of covered drugs)? to select the plan that is likely to have the lowest overall cost.
If you have followed all the steps in the series, you now have a short list of plans to investigate.
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To start at the beginning of this series click here.