What are my options?

Here’s a Fun Fact:

Where you live (the county that you live in, specifically) will determine what Medicare Advantage (and stand-alone prescription drug plans) are available to you. As if this isn’t overwhelming enough, now consider that each health insurance company offering plans in your county probably has more than one plan to choose from. It can feel overwhelming, so how do you choose?

When I’m working with clients I typically start with the questions about the doctors and

other healthcare providers they prefer to use as well as prescription drugs that they take. Unless you’re open to making changes to the doctors you see and to minimize your out-of-pocket costs, you’ll want to make sure that they are in the health plan’s network. Making sure that your prescription drugs are covered at the lowest possible copay costs is also an important consideration.

Medicare Advantage plans are typically very competitive and while you may see some differences in the monthly premium, copays and maximum copay out-of-pocket costs, making saving money your first priority could be at the expense of not being able to see the doctors or use the hospitals you prefer.

Once you’ve narrowed your Advantage Plan choices you can start to consider whether you prefer an HMO (Health Maintenance Organization) with in-network benefits only or a PPO (Preferred Provider Organization) with in and out-of-network benefits. Keep in mind that even if you choose a PPO plan with out-of-network benefits, you’ll most likely pay higher copays when you see non-contracted or out-of-network providers. That said, even when I know that my client will only consider a PPO, I still want to make sure that their doctors are in network so they don’t incur higher copays.

Don’t forget to check the health plan’s drug formulary to make sure that your prescriptions are covered at the lowest possible copay cost. Other things to take into consideration are things like prescription drug deductibles that may apply, quantity limits and prior authorization requirements.

Now that you’ve narrowed the list of plans to consider you can start comparing things like:

  • Monthly premium cost

  • Maximum copay out of pocket limit

  • Medicare Star Ratings

  • Copays and co-insurance amounts

  • Extras; vision, dental, hearing aids, transportation, over-the-counter product allowance

  • Gym membership options

Advantage plan benefits are subject to change annually, so think of your plan choice as a one-year commitment. And remember, the plan that meets your needs this year may not be the right fit next year should your healthcare needs or budget change. Each fall, during the Medicare Annual Enrollment Period (AEP), October 15th thru December 7th , you will have an opportunity to make sure that the plan you’ve chosen is going to be a good fit for the upcoming year. Your Annual Notice of Change (ANOC) document should be in your mailbox by October 1st and this is a great place to start. The Medicare Plan

Finder (https://www.medicare.gov/plan-compare/#/?lang=en&year=2021) is an excellent source of unbiased information. Don’t forget that a Medicare insurance agent should have good insights into the plans available in your area.

Bottom line, taking some time to make sure that your Medicare plan is a good fit for your budget and lifestyle could save you headaches as well as money.

Liz McPherson is an independent insurance agent that only sells Medicare plans and owns the Colorado Springs Medicare Resource Center. She lives in Woodland Park, Colorado with her husband, 4 dogs, 3 cats and a horse named “Dottie West”. She’s worked in the “Medicare world” since 2005 in both health plan operations and sales management. A proud graduate of Slippery Rock University (BA in Political Science) and University of Phoenix (MBA in Healthcare Management) she wears her nickname of

“Medicare Nerd” as a badge of honor.

You can reach Liz at:



O: (719) 358-6696

C: (719) 243-0965 (text friendly)

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