Which Medicare Plan is Right for You?

Choosing which Medicare coverage is right for you can seem like a difficult decision. Each plan is different, and you want to make sure all your health needs are covered. However, it is possible to decide which Medicare plan is right for you – and the choice doesn’t have to be difficult.

Let’s keep the decision process simple. As you review the different Medicare parts and the coverage they provide, the answers to the following questions may be able to guide you in the right direction.

  • Do you visit the doctor frequently?

    Medicare Parts A and B may require you to pay a percentage of the doctor’s fee for doctor’s services, while Medicare Advantage plans often require you to pay a copay or coinsurance for each doctor office visit. According to the Official U.S. Government Website for Medicare, in some cases Medicare Savings Programs may offer assistance in paying for Part A and Part B deductibles, coinsurance and copays for individuals with limited income and resources.

  • Do you plan to use a specific doctor or pharmacy?

    Prescription drug plans (PDP), Medicare Advantage (MA) plans and Medicare Advantage-Prescription Drug plans (MA-PDP) each use a unique network of providers and pharmacies to provide plan members with lower out-of-pocket expenses. If your preferred doctor or pharmacy is not in the plan’s network, your out-of-pocket costs may be higher.

  • How often do you use prescription drugs?

    If you use prescription drugs on a regular basis, you may want to consider some type of prescription drug coverage. If you choose not to obtain drug coverage, you could face a Part D late enrollment penalty if you decide to sign up for coverage later.

  • Do you have a long-term health condition like heart disease or diabetes?

    Not only do serious health conditions often require frequent doctor office visits, they may also require that prescription drugs be taken frequently as well. Make sure the plan you choose covers all the medical necessities and/or prescription drugs you need.

  • Do you have any planned inpatient procedures approaching?

    Medicare Part A and Medicare Advantage plans cover many inpatient expenses, such as medical supplies and drugs used while in the hospital to manage symptoms and pain, operating room and recovery room services, and more. A Medicare Part B plan may not provide coverage for all of these same inpatient services. Therefore, if you have inpatient procedures approaching, you may want to make sure the part of Medicare you choose covers the expenses. For example, Part B may cover the doctor services you receive as a hospital inpatient, but other hospital services (such as room fees and medical supplies) are covered under Part A.

  • Which drugs do you take?

    Each Medicare Part D plan has its own formulary (list of drugs), so the plan may or may not cover the prescription drugs you take. Check the plan’s formulary to be sure.

  • Do you live in a long-term skilled nursing facility?

    Only a certain number of days spent in a skilled nursing facility are covered by Medicare. Before choosing a plan, find out how long you will need to have the care covered and at what price.

  • Would you rather have a plan with a yearly deductible, or would you rather have a $0 deductible plan with either higher copays or a higher monthly premium?

    Different plans have different premiums, deductibles and copays. Compare costs and decide which plan works best for your budget.

  • What are your previous out-of-pocket healthcare expenses?

    Take a look at what you’ve previously spent on things like doctor office visits and prescription drugs over the past year. This will help you better evaluate the costs associated with each type of Medicare plan and determine what works for you.