4 Reasons To Consider a Different Medicare Plan From Your Spouse
Key Takeaways
- There are no family plans on Medicare, but many married couples make the same decisions about their coverage.
- Spouses can find the best coverage for their own individual needs by exploring their Medicare Advantage plan options.
- Some key considerations include provider networks, prescription drug coverage, additional benefits, and care for a chronic condition.
You share a lot in a marriage, from the big things like a home down to a nibble of your dessert.
For many couples, that includes health insurance, but you can’t share a plan once you’re over 65 and enroll in Medicare. Whether you’re on Original Medicare, which is administered by the federal government, or you’ve chosen a Medicare Advantage plan from a private insurance carrier, that coverage is just for you as an individual.
Medicare Advantage plan details and availability can vary greatly depending on where you live, and carriers may offer several options tailored to enrollees’ health and financial needs.
Still, a lot of people make decisions about Medicare that align closely with their spouses. A study conducted by University of Michigan researchers looked at the enrollment decisions of 1,812 married couples on Medicare Advantage plans:
- When the study began, 84% of the subjects were on the same plan as their partner.
- Most people stayed with the plan they’d enrolled in for the next year.
- In cases where one partner changed plans after a year, 86% of their spouses did as well.
Your partner’s perspective is valuable when making healthcare decisions. However, when it comes to selecting coverage, you might be better served by working with a licensed insurance agent to choose your plan separately. Here are some reasons why.
1. You Prefer To See Different Doctors
People on Original Medicare are covered for visits with any healthcare provider who accepts assignment, meaning they’ll take a Medicare-approved amount as their full payment for services. If you’re enrolled in a Medicare Advantage plan, on the other hand, you likely need to see doctors and visit pharmacies in your provider network to get the most out of your benefits.
Selecting a primary care provider and any specialists you need to see can be a very personal decision. For example, you might have areas of concern in your own or your family’s medical history and want to see a doctor who has relevant expertise. Otherwise, you might feel more comfortable talking openly with a provider you’ve known for years.
You and your partner both deserve to get care from the providers you trust. When exploring the possibilities, you should check whether your preferred doctors and pharmacies are part of a plan’s network before enrolling.
2. You Need Coverage for Specific Drugs
To get help with the costs of most medications, people on Medicare need a Medicare Part D prescription drug plan. If you’re on Original Medicare, that means signing up for a standalone plan from a private carrier. However, many Medicare Advantage plans include Part D coverage.
Whether you opt for standalone Part D or a Medicare Advantage prescription drug plan, you will likely have several to choose from. Based on where you live and what carriers have to offer, there may be significant differences in the plans’ formularies (the lists of what medications they cover) and how much you’ll pay out of pocket.
Formularies have tiers of coverage that affect how much you’ll pay in coinsurance. Carriers often classify more expensive drugs in upper tiers that require patients to cover a higher percentage of the cost. If you or your spouse take one of these medications, you should research what plan gives you the most savings on a regular supply.
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3. You’re Looking for Different Benefits
On top of coverage that substitutes for Original Medicare, Medicare Advantage plans may provide a range of additional benefits. These might include dental, vision, and hearing services. Some plans provide access to gyms or online fitness classes.
Even if two plans include benefits in the same categories, the details can be far apart; you should prioritize the combination of features that’s right for you, not your spouse. For example, if you’ve noticed that you’re having a harder time seeing things up close, you may be interested in a vision plan that provides a higher allowance for glasses and frames. Meanwhile, your partner might be more concerned about finding a plan with comprehensive dental care or with a wide selection of free fitness activities.
4. You or Your Spouse Live With a Chronic Condition
Chronic health issues often require careful monitoring of symptoms, frequent trips to multiple specialists, and a strict routine of diet and exercise. The right insurance empowers you to keep up with the demands of treatment for one or more chronic conditions. If you or your spouse have been diagnosed with or are at high risk for cancer, an autoimmune disorder, diabetes, cardiovascular problems, asthma, or a variety of other conditions, that should shape your coverage choices.
One option you may consider is joining a chronic condition special needs plan (C-SNP) if an appropriate one is available in your area. These Medicare Advantage plans are specifically for people who live with a chronic illness or disability.
C-SNP plans are required to include Part D prescription drug coverage, and the formularies are designed to provide the medications commonly prescribed for a particular condition. The provider networks ensure you have access to doctors and hospitals equipped to manage your medical needs. Plans may also feature additional benefits to help with your overall health and quality of life.
Your spouse can play an important role in your healthcare, but your personal situation should be the top priority when picking a plan. Get in touch with a licensed insurance agent to discuss what you’re looking for in your coverage.
Sources
In sickness and in health, older couples mostly make Medicare moves together. University of Michigan Institute for Healthcare Policy and Innovation.