How to choose a Medicare plan: Things to consider

Finding the right Medicare Plan for you can be confusing. There are so many different options and rules. By understanding your choices, you can find a plan that meets your financial needs and helps you stay healthy. The following information can help you understand your options and make your decision easier.

Understanding your Medicare plan options

The first step in choosing a plan is understanding the difference between Original Medicare and a Medicare Advantage plan.

Medicare Advantage vs. Original Medicare

Original Medicare

Medicare is a federal insurance program for people 65 and older or those with certain disabilities or end-stage renal disease. It is broken up into two parts: Part A (hospital insurance) and Part B (medical insurance).

• Medicare Part A covers hospital and inpatient care. It includes services such as inpatient hospital stays, skilled nursing facility care following a hospital stay, hospice care, and some home health care services. Part A is premium-free for most people if they or their spouse paid Medicare taxes while working.

• Medicare Part B covers medical services and supplies needed to diagnose or treat a medical condition. This includes services like doctor visits, outpatient care, preventive services, durable medical equipment, lab tests, and home health care services. Part B typically requires a monthly premium that varies based on income.

Medicare Advantage

Medicare Advantage, or Medicare Part C, is a type of Medicare plan offered by private insurance companies approved by Medicare. It combines coverage for hospital services (Part A), medical services (Part B), and sometimes prescription drug coverage (Part D) into a single plan. Part C often includes extra benefits like dental, vision, hearing, and wellness programs.

What to consider when choosing a Medicare plan

When choosing a plan, here are some factors to consider to help find the plan that meets your needs and budget:

1. Cost of coverage: How much will you have to pay out-of-pocket?
   1. Original Medicare only pays about 80 percent of costs. You are responsible for the remaining 20 percent, without limits.
   2. Medicare Advantage plans may have monthly premiums, depending on your plan, and you still need to pay your Medicare Part B premium. Most Medicare Advantage plans do not have a deductible and have a maximum out-of-pocket to limit your health care costs.
2. Benefits: What is covered?
   1. Original Medicare covers inpatient and outpatient care, but you will need to enroll in a separate drug plan.
   2. Medicare Advantage plans cover everything that Original Medicare covers, and most plans also include prescription drugs coverage.
3. Plan network: Are your doctors covered?
   1. With Original Medicare, you can go to any doctor or hospital that accepts Medicare.
   2. Depending on the type of Medicare Advantage plan, you may be required to get your medical care from a set network of providers. Check the plan network to make sure your preferred doctors and hospitals are covered.
4. Part D coverage:
   Do you regularly take prescription medications? Most Medicare Advantages plans include Part D coverage while Original Medicare does not. It is important to check the plan’s formulary (drug list) to ensure that your medications are covered.
5. Additional benefits:
   What extra benefits are important to you and your health needs? Medicare Advantage plans offer extra benefits not covered by Original Medicare. Some of these benefits include dental, vision, hearing, gym memberships, home health products, and allowances for OTC products.
6. Personal health history:
   How often do you need care? If you have a chronic condition that requires ongoing care, it is important to find a plan that covers all your health care needs. If you are healthy, you may not need as much coverage but want extra benefits that help you stay healthy and active.

Choosing your Medicare Plan

Choosing the right Medicare plan is different for everyone. Cost is important, but knowing your specific health needs can help you anticipate what coverage you will need and use. Here are some examples to help you understand which plan may be best based on your situation.

If you like your current doctor and don’t want to switch, Original Medicare might be a good choice because it lets you visit any doctor that accepts Medicare. But remember, it doesn’t cover everything, so you may need extra insurance for prescriptions and other costs. You could also find a Medicare Advantage plan that covers your doctor in-network or choose a PPO plan that offers coverage in and out-of-network.

For someone who needs extra benefits like dental, vision, and hearing, a Medicare Advantage plan could be a better fit. These plans often include benefits not covered by Original Medicare. For example, if you need glasses or dental visits, a Medicare Advantage plan can help cover these costs.

If you have Medicare and Medicaid, you may qualify for a Special Needs Plan (SNP). These plans are designed to help people with specific health issues and provided specialized care.

Everyone’s situation is different, so it’s important to think about your health needs and what you want from your Medicare plan. Taking time to compare your options can help you find a plan that’s right for you.

Next steps for choosing your Medicare plan

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Medicare Advantage vs. Original Medicare

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