Picking the Right Medicare Plan

Step 1
Decide whether you want to use Original Medicare or get your Medicare benefits through a Medicare Advantage plan. 

Original Medicare (Parts A and B): 

•    Covers your hospital visits
•    Covers your doctor’s visits
•    Doesn’t cover routine dental, vision, or hearing care
•    Doesn’t include prescription drug coverage
•    Doesn’t include other wellness benefits, like a gym membership
•    Allows you to see any doctor or go to any hospital that accepts Medicare
•    Includes some out-of-pocket costs you’ll have to pay, for premiums, copays, coinsurance, and deductibles

Medicare Advantage: 

•    Includes the same coverage as Original Medicare (you have to sign up for Medicare Part A and Part B to get a Medicare Advantage plan)
•    Covers your hospital visits/inpatient care
•    Covers your doctor’s visits/outpatient care
•    Often includes routine dental, vision, or hearing care
•    Often includes other fitness and wellness benefits, like gym memberships and more
•    Often includes Medicare Part D prescription drug coverage
•    Includes a network of doctors you can choose for your care
•    Includes some out-of-pocket costs you’ll have to pay, for premiums, copays, coinsurance, and deductibles

If you choose a Medicare Advantage plan, make sure to find out if your doctors are listed in the plan’s network. Also, think about what type of Medicare Advantage plan will best fit your health care and lifestyle needs. 

PPO: If you select a Medicare Advantage PPO plan, you’ll have more freedom to see the doctor of your choice. For example, you typically won’t have to check with your primary care doctor before you see a specialist. And most PPO plans often include greater coverage for people who travel away from home frequently. But your out-of-pocket costs may be higher with this type of plan. 

HMO: If you choose a Medicare Advantage HMO plan, you’ll have a close relationship with your primary care doctor. Your primary care doctor will coordinate the care you receive from all the doctors you see. Typically, your out-of-pocket costs will be lower with this type of plan

Step 2
Will you get Medicare Part D prescription drug coverage? 

If you are choosing to use Original Medicare (Part A and Part B), make sure to select a Medicare Part D prescription drug plan to cover your medication costs. Original Medicare doesn’t cover the costs of your prescription drugs. And if you don’t select a Part D plan when you are first eligible, you may have to pay a Late Enrollment Penalty if you decide to enroll in Part D coverage later. 

If you have to pay a Late Enrollment Penalty, you will have to pay this fee as long as you have Part D coverage. So, it’s important to select a Part D plan when you are first eligible.  

If you decide to enroll in a Medicare Advantage plan, make sure your plan comes with Part D prescription drug coverage, too. 

No matter whether you enroll in a stand-alone Medicare Part D prescription drug plan or get Part D prescription drug coverage through your Medicare Advantage plan, keep these things in mind:

•    Make sure to look at the formulary (list of covered drugs). Are your medications covered? 
•    What will your medications cost?
•    Is mail-order offered for prescription medications?
•    What retail pharmacies are included in the plan?
•    Your out-of-pocket costs will depend on the plan you choose.

Step 3
Will you get a Medicare Supplement (Medigap) policy to help pay your out-of-pocket costs? 

Medicare Supplement (Medigap) policies help pay out-of-pocket costs Original Medicare does not cover, like copays and coinsurance for the health care you receive and your monthly Medicare Part B premium.

Here are some important things to consider about buying a Medicare Supplement policy:

•    Most Medicare Supplement policies allow you to choose any doctor, specialist, or hospital that accepts Medicare. In most cases, you will have more freedom to select the doctor of your choice.
•    Your specific benefits and costs will depend on the policy you choose. 
•    When you apply for a Medicare Supplement policy, the insurance company you choose may factor in your age, tobacco use, and county of primary residence to determine if you qualify for their plan. Make sure to ask what criteria the company considers before you apply for a policy.