Select Medicare coverage for the “future” you

Michael:  I read your Social Security book and am now about 70 percent through your Medicare book. Is there an obvious best route to follow for Medicare regarding signing up for Original Medicare (Parts A and B), a Part D drug plan and Medigap versus getting a Medicare Advantage plan? My wife and I are both 68 or soon to be. One of us has some expensive medicines. We do not have any major chronic illnesses.

Phil Moeller: I don’t believe there is a purely objective answer to your question, but you should be guided by your health and financial conditions. There are solid reasons to support each of these Medicare choices. Original Medicare, with a Part D plan and Medigap, is the more expensive option of the two, but generally provides more complete coverage and more choice in the health care providers you can use.

One big factor from where I sit is that Medicare choices should be designed to protect the “future” you, not the “present” you. You may be blessed now with good health, but there are no assurances that this will be the case in the next five minutes, let alone the next five or 10 years.

Personally, and with sufficient funds available, I believe in getting the most comprehensive coverage possible, and right now, I would have trouble achieving this goal with a Medicare Advantage plan. My primary concern regards being limited to the doctors and hospitals in a plan’s network. I have no idea what medical specialists I might need in the future. I do know that Original Medicare will cover me with any doctor or institution that accepts Medicare. I have no certainty about who I would be able to see if I had a Medicare Advantage plan.

Secondarily, Medicare Advantage plans are based on local or regional coverage. Many plans do not cover you if you travel in the U.S. outside your home market. Original Medicare provides coverage anywhere in the U.S. Some Medicare Advantage insurers are including broader coverage in their plans, but again, why should I have to worry about this if I can afford Original Medicare and a Medigap plan?

Having said this, Medicare Advantage plans can be much, much cheaper than the most comprehensive approach with Original Medicare, Part D and Medigap. They also may cover things that the other package does not, such as limited dental, vision and hearing insurance and athletic club membership. They have ceilings on out-of-pocket spending, and thus provide the same kind of protection as do Medigap plans.

If you do not have a warm-weather second home and spend all your time in your home market, the regional coverage limits of a Medicare Advantage plan would never be a factor. Lastly, if you find a plan that includes your preferred doctors, hospitals and other health providers, you would be well-positioned to look out for the medical needs of a “future” you.