Searching for the right Medicare plan can be a little daunting, but it doesn’t have to be complicated. It’s all about being well-prepared and covering your bases.
You want to start your journey as informed as possible, so you can make the best choice. This means asking the right questions about coverage, networks and doctors, plan benefits and more.
Here’s what you need to consider when picking a Medicare plan, including who can help you get started and important coverage considerations.
Who can answer my Medicare questions and help me choose a plan?
Before we talk about what to ask, let’s talk about who to ask. There are a lot of ways to sign up for Medicare or to get the information you need before choosing a plan. For many, their Medicare journey starts directly with Medicare.gov, the official website run by The Centers for Medicare and Medicaid Services. There you can research and compare plans in your area or call to talk to an agent about getting started.
You can also look for individual Medicare brokers, advisors and sales teams in your area. These agents can answer your questions, help you choose a Medicare plan and get you enrolled.
What questions you need to ask when choosing a Medicare plan
If you’re meeting with someone from a health insurance company or going to a Medicare informational meeting, you’ll first need to consider what elements of a plan are most important to you. This will help you narrow down what you may need to ask.
Key questions to ask might touch on topics such as:
- Overall coverage cost
- Additional benefits, like hearing, vision and travel coverage
- Medicare Part D coverage for medicines
- Staying with your current doctor or switching providers
- Possible perks like gym memberships and additional services
What are the types of Medicare?
In general, Medicare is broken up into four parts, including Original Medicare (Parts A and B), Medicare Advantage plans (Part C) and prescription drug coverage (Part D). Certain types of plans may cover only specific parts, offering different kinds of coverage.
Before you pick a plan, you should take a good look at your own care and coverage needs. Do you need a large network of doctors? Do you take a lot of medicines? This will help you start narrowing down what type of Medicare coverage may work best for you.
- Original Medicare is health insurance coverage provided by the federal government for those over the age of 65 or with certain disabilities. It covers Part A (hospital insurance) and Part B (medical insurance). This includes things that are considered medically necessary, such as hospital stays, routine doctor visits, outpatient services and more.
- Medicare Advantage (Part C) is Medicare coverage that can be purchased directly from a private health care company. These plans work as an alternative to Original Medicare, combining the coverage options of Parts A and B, as well as additional benefits such as dental, vision and prescription drug coverage (Part D). It’s a very convenient way to have all your coverage options in one place.
- Medicare Supplement plans are a great addition for those with Original Medicare, helping you cover expenses like deductibles, coinsurance and copays. After receiving care, a Medicare Supplement plan will pay its share of what Original Medicare didn’t cover – then you’ll be responsible for whatever remains. Medicare Supplement plans typically don’t include prescription drug coverage.
- Medicare Part D plans help cover the cost of the prescription drugs you take at home, like your daily medicines. You can enroll in a separate Part D plan to add drug coverage to Original Medicare, a Medicare Cost plan or a few other types of plans.
How much will I have to pay for coverage?
For many, this is often the first question considered when searching for a Medicare plan. The cost of Medicare varies depending on your health care needs, financial assistance eligibility and how you choose to get your benefits.
No matter what you’re looking at, make sure to confirm the following costs:
- Premium: What you pay for your coverage each month
- Deductible: What you pay for services before your insurance plan begins paying
- Copays: A fixed amount you pay for a covered service after your deductible has been met
- Coinsurance: A percentage of the costs of a covered service you pay after your deductible has been met
What does “covered” mean?
If something is “covered,” it means your Medicare plan will help you pay for it. How much depends on the type of care you use and where you get it. To get the most cost-effective health care, you’ll want all the services you use to be covered by your Medicare plan.
Some covered services are completely free to you, like going to the doctor for preventive care screenings and tests. Your plan pays everything. For others – like seeing the doctor for a lingering sinus infection or filling a prescription for covered antibiotics – you’ll pay a fee. The amount you pay will be different depending on the type of plan you have and whether or not you’ve taken care of your deductible.
Does the plan include prescription drug coverage (Part D)?
Medicine is an important part of care for many people, especially those over the age of 65. However, Original Medicare doesn’t include prescription drug coverage. Private Medicare health plans with Part D prescription drug coverage and standalone Medicare Part D drug plans can help make sure you get access to and coverage for the medicines you need.
Ask your advisor about prescription drug coverage options, and then make sure to have a list of questions ready for additional information, such as:
- How much will I have to pay each month (premium)?
- How much will I have to pay before my plan helps me pay for my care or medicines (deductible)?
- Are my regular medicines covered?
- Can I get my medicines at my regular pharmacy and/or in the mail?
Will I be covered if I need care when I’m traveling?
It’s important to make sure you’re covered, no matter where you go. Original Medicare typically covers health care visits when you’re traveling across the U.S. and seeing a provider who accepts Medicare. But what about traveling abroad? Many Medicare Advantage plans provide international coverage, as well as coverage while you’re traveling domestically. If you plan on traveling, make sure to ask your Medicare advisor about what is and isn’t covered.
Can I keep my current doctor?
Maybe you’ve been with your current doctor for a while, and you want to keep seeing them. We get it – it’s important to have a doctor you’re comfortable with who understands your medical history. Many people who make the switch to Medicare continue seeing their regular doctor, but for some, it’s not that simple.
If you’re working with a Medicare advisor, you can ask them if your doctor will be in network with your new plan. But if you’re looking at plans independently, you may have to click some links and make some calls.
For those interested in Original Medicare, you can use the Medicare.gov website to look up your existing doctor or another provider, clinic or hospital you want to use.
For Medicare Advantage plans and Cost plans, you can call the insurance company to make sure the doctors you want to see are covered by the plan you’re interested in. You can also check the plan’s website to see if they have an online search tool to find a covered doctor or clinic.
No matter what kind of plan you’re looking at, if your current doctor isn’t in network, it’s time to start laying the foundation for finding a new primary doctor. Additional questions can include:
- If I need to see a new doctor, do I have to pick him or her from a specific list (network)?
- If I need to see a specialist, can I make an appointment myself without a referral?
Does this plan offer additional benefits like hearing, vision and dental coverage?
Hearing, vision and dental care are all important pieces of overall health care. However, they’re typically not covered by Original Medicare, with a few exceptions. Good news! Some Medicare Advantage and Cost plans do cover these services, so you don’t have to go without support. Let your advisor know if these benefits need to be included in your care, and they can help you find the plan that works best for you.
What kind of perks will I get if I’m a member?
If you’re looking for additional benefits that Original Medicare doesn’t cover, Medicare Advantage and Cost plans offer a host of perks, such as:
- Fitness programs and gym memberships
- Travel coverage
- Transportation assistance
- Over the counter (OTC) allowances
- Virtual care options
- And much more
Whether you’re looking for specific benefits or you just want a bird’s-eye view of potential offerings, make sure to ask your advisor. They’ll be able to tell you if you qualify for some of these benefits and if there are any restrictions or limitations you need to know about.
Which Medicare plan is best for you?
So, which Medicare plan should you go with? That’s the best part – you have options. And ultimately, the choice is up to you. Remember, when getting started, it’s important to make sure you’re as informed as possible. Start with a list of considerations, make sure you’re asking the right questions and begin focusing on what type of plan will best serve you and your needs.