Finding Medicare Resources

What’s in this article:

• Start with your own needs
• Begin with official Medicare resources
• Use SHIP for free, personalized help
• Insurance brokers can help, but understand their role
• Compare total cost, not just premiums
• The bottom line
• Additional Coldstream resources

Choosing Medicare coverage can feel overwhelming because there are actually several important decisions wrapped into the process. You may be comparing Original Medicare to Medicare Advantage, considering a Medigap policy, determining whether your doctors are in-network, and trying to account for your own health and drug needs. Some of these decisions are easier to make at the outset than to change later, so it is important to think not only about what you use today, but also to consider what you may need in the future.

Because the choices you make can affect your costs and access to care for the rest of the year (at least), it’s worth utilizing the available resources to ensure you are making the best decision for your health coverage.

Start With Your Own Needs

Maybe it’s too obvious to mention, but the first consideration is determining what is most suitable for your own health. Medicare isn’t one-size-fits-all, so the best decision depends heavily on your doctors, medication, budget, and how extensive your needs are.

Start by making a simple list of:

• The doctors and specialists you want to keep
• Your medications
• Preferred pharmacies
• Budget
• Family history
• Upcoming treatment
• Whether you need coverage while traveling or crossing state lines
• How important vision, dental, or hearing are to you

Doing this up front makes the process much easier when utilizing other resources to evaluate your Medicare options. Often, the cheapest plan isn’t the one that best suits your needs. A plan may look more affordable at first, but you may end up paying more if you need out-of-network providers or face additional out-of-pocket costs for services or prescriptions your plan does not cover well.

Begin With Official Medicare Resources

There is an endless wave of TV commercials, radio ads, and other advertisements that often represent the first exposure people have to Medicare information. These sources make urgent claims about benefits and actions, but most of this information is tied to marketing efforts from private providers with a sales bias. The best place to start is one of the most obvious: go straight to the source.

Useful starting points are:

• medicare.gov
• 1-800-MEDICARE
• The official Medicare & You handbook
• Medicare: Learn about Medicare basics

These resources explain how Medicare works, outline your coverage options, and help compare coverage plans in your area. The biggest benefit of starting here is that these resources are designed to inform rather than sell. They aren’t trying to steer you to a specific product or private plan and instead are simply providing information about how the program operates.

The Medicare & You handbook is a helpful, broad overview of Medicare while the website has a plan comparison tool that is built to evaluate your options based on prescriptions, coverage priorities, and other criteria. The comparison tool will be more effective if you have itemized your own priority items beforehand. You can find a number of other publications on the Medicare website that may provide additional helpful information.

Use SHIP for Free, Personalized Help

Once you have familiarized yourself with some of the basics, speaking to the State Health Insurance Assistance Program (SHIP) is one of your best next steps. SHIP counselors provide free, local, unbiased Medicare counseling and can provide expertise while you compare plans, understand enrollment periods, review costs, and explore coverage options. The Medicare website specifically identifies SHIP as a great resource for participants, particularly if:

• You’re enrolling in Medicare for the first time
• You have multiple prescriptions
• You’re deciding between Medicare Advantage and Medigap
• You are worried about costs
• You want unbiased help going through your options

For example, a key early decision in Medicare is if you should opt for Original Medicare + Medigap + Part D coverage OR Medicare Advantage. Original Medicare paired with a Medigap policy generally provides more flexibility in providers, is better for those who travel, and has more predictable out-of-pocket expenses. The downside is that the monthly premiums are usually higher.

Medicare Advantage typically has lower premiums and can include extra benefits like dental, vision, and hearing. Unfortunately, it typically relies on specific provider networks and may prove more difficult to navigate the required approvals to get care.

These are the kinds of decisions a SHIP counselor can help you work through to find the most suitable elections. Bringing your list of medications, doctors, pharmacy preferences, and plan materials will help you make the most of your SHIP appointment. The more specific you can be about what you need and want, the more productive the appointment will be.

Insurance Brokers Can Help, But Understand Their Role

Once you have started to build some clarity around your options and preferences, insurance brokers can be useful sources of information regarding plan options sold in your area. Many brokers are familiar with Medicare Advantage plans, Part D coverage, and Medigap policies. They may simplify the shopping process, but it’s important to be aware of their role.

Brokers are typically compensated by the insurers whose plans they sell, so their role is different from that of Medicare.gov or a SHIP counselor. They may be incentivized to steer you in a particular direction.

If you decide to work with a broker (and you may decide to buy a policy through them, depending on your options), ask a few practical questions:

• Which insurers do you represent?
• Are these all of my options or are you unable to offer certain providers?
• How does this recommendation fit my doctors, medications, and budget?
• What tradeoffs should I be aware of?

Compare Total Cost, Not Just Premiums

Cost is, of course, a primary consideration when looking at Medicare options, but a common mistake is equating cost to premiums. While the premium is the monthly cost of the insurance itself, it doesn’t mean your total medical expenses will be lower if it doesn’t meet all your coverage needs. Copays, deductibles, network restrictions, drug coverage, and out-of-pocket maximums all play a role.

As you compare plans, it is important to evaluate:

• Can you keep your current doctors?
• Are prescriptions covered?
• Will this plan work well if your health needs increase?

These questions matter more than the headline price of the policy and will factor into your total cost. A plan that works well for someone with minimal care needs today may feel very different if specialist visits, ongoing treatment, or expensive prescriptions become part of the picture later. Work with a SHIP counselor to determine how your non-premium costs change for each plan.

The Bottom Line

Medicare decisions are complicated, but they become more manageable when utilizing resources available to you. Start with your own healthcare needs and compare those to existing plan options on www.medicare.gov. SHIP counselors can offer unbiased guidance in navigating all your available options while brokers can offer some plan-specific guidance.

Start with your own list of needs, verify your options through Medicare.gov, and use SHIP if you want unbiased guidance. The best Medicare decision is rarely the fastest one or the one with the lowest advertised premium. It is the one that best fits your doctors, medications, budget, and likely future health needs.

Additional Coldstream Resources:

• Filing for Medicare: What to Consider When Claiming Benefits
• Navigating Medicare Open Enrollment: Your Guide to Making the Right Choices
• Ask the Expert Videocast: Willamette Valley Benefits

This article is for informational and educational purposes only and does not constitute legal, tax, insurance or personalized financial advice. Readers should consult with qualified professionals regarding their specific circumstances. Coldstream does not sell Medicare insurance products and does not receive compensation from insurance carriers or brokers in connection with Medicare coverage decisions.

Certified Financial Planner Board of Standards, Inc. (CFP Board) owns the certification marks CFP® and CERTIFIED FINANCIAL PLANNER® in the United States.

Coldstream Wealth Management is an SEC-registered investment adviser. Registration does not imply a certain level of skill or training.