How Do I Find a Medicare Health Plan?
This article was updated on: 08/22/2018
Most people are automatically enrolled in Original Medicare (Part A and Part B) when they retire and begin accessing their Social Security benefits. If this is true for you, you may not need to find a Medicare health plan as you are automatically enrolled in one already. Original Medicare offers a range of benefits for inpatient, outpatient, and rehabilitative care to help seniors and other beneficiaries offset their health-care costs, and there are usually other options under the Medicare program as well. Learn about Medicare health plans and Prescription Drug Plans.
What benefits do I get with Original Medicare?
Before talking about the Medicare health plan options you may have, let’s start with the basics. Original Medicare consists of Part A and Part B. Part A generally covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Part B may provide coverage for doctor visits, tests, treatments, and supplies your doctor believes are medically necessary to treat your condition. Notable exceptions to Original Medicare coverage include:
- Prescription drugs (in general – next section for more information)
- Routine dental care
- Eye exams and prescription eyewear or contact lenses
- Hearing evaluations and hearing aids
- Wellness programs and fitness plans
In addition, you must pay deductibles for both Part A and Part B, and there is coinsurance or a copayment amount due for most covered expenses. There are no limits to the out-of-pocket expenses you may be required to pay each year for your health care.
How can I find other Medicare health plans to supplement my Original Medicare benefits?
Original Medicare includes only certain prescription drug benefits and doesn’t cover most medications you’d take at home. For example, Part A generally covers medications administered to you as a hospital inpatient, while Part B usually covers medications administered to you in an outpatient hospital or office setting.
In 2006, Medicare Part D Prescription Drug Plans became available to enrollees to help cover the costs of prescription medication, according to the Centers for Medicare & Medicaid Services (CMS). Most plans have an annual deductible (maximum of $405 in 2018) before they pay for prescription drugs, less a copayment or coinsurance amount, although some offer “first dollar” coverage. There may also be catastrophic coverage after you pay a certain amount each year for your prescriptions, but before you reach that stage you’d reach the coverage gap or “donut hole.” Many people never even reach the coverage gap; it depends on how much you and your plan spend on your prescription drugs.
Each Medicare Prescription Drug Plan uses a formulary, or list of covered prescription drugs. When you’re looking for plans, you might want to make sure your plan’s formulary covers your prescriptions. A plan’s formulary may change at any time. When required by law, you will receive notice from your plan of changes to the formulary.
You may want to sign up for a stand-alone Medicare Prescription Drug Plan as soon as you are eligible for Medicare; you may pay a late enrollment penalty with your monthly premium if you delay. You can find a Medicare Part D Prescription Drug Plan offered by a private insurance company contracted with Medicare. Medicare Part D Prescription Drug Plans are offered by private insurance companies contracted with Medicare.
If you decide to stay with Original Medicare, another option you may have is to sign up for a Medicare Supplement insurance plan (Medigap) to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Like Medicare plans with prescription drug coverage, you can find a Medicare Supplement plan from a private company. They may also offer additional benefits not available under Original Medicare such as limited foreign travel emergency coverage.
Plan benefits and premiums may vary by location and insurance company, and not all plans are available in all locations.
Can I find a Medicare health plan that provides similar benefits as Original Medicare?
In most cases, you may elect to get your Medicare Part A and Part B benefits through the Medicare Advantage program, also known as Medicare Part C. These plans offer all the same coverage as Original Medicare (except for hospice care, which is still covered under Part A), but most offer additional benefits including prescription drug coverage, benefits for routine vision, dental, and hearing care, and/or coverage for fitness and wellness programs. They offer a convenient way to get all your Medicare benefits in one plan.
To enroll in a Medicare Advantage plan, you must be enrolled in Medicare Part A and Part B and live within the plan’s service area. You may be ineligible if you have end-stage renal disease (ESRD). You must continue to pay your Part B premium if you enroll in a Medicare Advantage plan; some plans also require an additional monthly premium. As with stand-alone Medicare Part D Prescription Drug Plans, Medicare Advantage plans are offered by private insurance companies approved by Medicare, and plan benefits and premiums may vary according to where you live and which insurance company you get your plan from.
How do I find a Medicare health plan?
To find Medicare health or Prescription Drug Plans in your area, you can use the simple plan finder tool on this page – just enter your ZIP code to get started. If you take daily medications, you can also enter your prescription drugs to find Medicare Part D Prescription Drug plans and Medicare Advantage plans that cover your medication. You can also call participating insurance companies directly to learn more about their plans.
I would be happy to help you find a Medicare Advantage, Medigap, or Medicare Part D Prescription Drug plan that works for you. You can request an email with information prepared for you, or schedule a phone call at your convenience by clicking one of the links below. To see a list of plans in your area you may qualify for, click the “Compare Plans” button.
Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.
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