It happens every fall. You're at the mailbox, or at a barbecue, or in line for coffee, and someone tells you about their Medicare plan. "I love it. You should get it."
They mean well. And their plan may truly be great. For them.
This came up at Fiscal Fridays last Friday. As one of our panelists put it, the plan your neighbor swears by "is not the right plan for you." Not because the neighbor is wrong, but because a plan isn't one-size-fits-all. As David told the room, "I know every one of you is unique."
Four things that make a plan personal
1. Your doctors
Many plans, especially Medicare Advantage plans, work with a network of doctors and hospitals. Your neighbor's doctors may be in it. Yours may not be. The only way to know is to check your own doctors, by name, for next year.
2. Your drugs
Every drug plan has its own drug list, and most sort drugs into tiers that cost different amounts. The same drug can sit on a different tier from one plan to the next. If your neighbor takes one pill a day and you take five, the same plan can feel completely different.
3. How you use care
On the show, the panel worked through a couple married 38 years. She takes seven prescriptions and sees three specialists. He takes one pill and sees his doctor twice a year. Medicare coverage is individual, so each of them can be on the plan that fits them. Your neighbor's routine is probably not your routine either.
4. Where you spend your time
Advantage plans are built around a local network. If you split the year between Arizona and somewhere else, or travel often to see grandkids, ask how the plan works when you're away. The neighbor who never leaves town may never have had to ask.
Three better questions
So the next time someone raves about their plan, enjoy the conversation. Then ask yourself three questions instead of "which plan do you have?"
- Are my doctors in it next year? Not this year. Next year.
- What would my drugs cost on it, at my pharmacy? Using your real list: the right names, strengths, and forms.
- What would a bad year cost me? Not just the premium. The most you could pay if your health takes a turn.
If the neighbor's plan passes all three for you, great. You both win. If it doesn't, you just saved yourself a headache.
Before December 7
The Annual Enrollment Period runs through December 7. If you'd like someone to run those three questions with you, call us at (602) 281-3898. Bring your drug list and your doctors' names. We'll do the comparing.
And tell your neighbor we said hello.
Disclaimer: This article is for educational purposes only. It is not sponsored, endorsed, or otherwise representative of Medicare or the federal Medicare program. American Retirement Advisors is not a government agency. For official Medicare information, visit medicare.gov or call 1-800-MEDICARE (1-800-633-4227).