Shopping for Medicare Plans? Read this Guide
Last Updated : 10/06/20187 min read
Medicare Part A, Part B, Part C, Part D…. Medicare Supplement… Medicare Advantage… What does it all mean? We hope this guide about Medicare will help make your options clear.
Medicare guide: what are the “parts” of Medicare?
- Medicare Part A is hospital insurance.
- Medicare Part B is medical insurance.
Part A and Part B make up “original Medicare,” the federal health insurance program for eligible people aged 65 or over, or who qualify by disability. Many people automatically get enrolled in Original Medicare as soon as they’re eligible.
- Medicare Part C is the Medicare Advantage program. Through Part C, you can get your Part A, Part B, and Part D (prescription drug) benefits through a single plan. (The exception is hospice care, which is covered under Part A). Private, Medicare-approved insurance companies offer Medicare Advantage plans, and sometimes include extra benefits such as wellness programs.
Please note that not every Medicare Advantage plan includes prescription drug coverage. You need to continue paying your Medicare Part B premium along with any premium the plan may charge.
- Medicare Part D is prescription drug coverage. This optional coverage is also offered through private, Medicare-approved insurance companies. You can get it through a Medicare Advantage Prescription Drug plan, or a stand-alone Medicare Part D Prescription Drug Plan.
As any guide about Medicare should tell you, each of these “parts” of Medicare might have a premium and deductible to pay, as well as coinsurance or copayments for doctor visits and other medical services.
Medicare guide: Medicare Supplement insurance
If you decide to stay with Original Medicare (instead of enrolling in a Medicare Advantage plan), you may be able to buy a Medicare Supplement (Medigap) insurance plan to help pay your Medicare out-of-pocket costs.
Medicare Supplement insurance plans generally pay at least part of your Part A and Part B coinsurance and copayments. Some help pay your Part A and/or Part B deductibles, and some may even help pay for emergency medical care during overseas travel.
Medicare Supplement insurance plans are sold by private insurance companies. Learn more about Medicare Supplement insurance.
Medicare guide: how do I choose what type of Medicare coverage to get?
Even a guide about Medicare can’t tell you what’s the best type of Medicare coverage for you. Only you can decide what kind of Medicare coverage fits your needs. But to help you get thinking about what matters to you, this table lists some factors to consider.
|If this is true for you…||You may want to consider….||But be aware that….|
|Saving money is very important to me, and I’m fairly healthy.||A Medicare Advantage plan, especially a Medicare Advantage HMO (Health Maintenance Organization) plan. Some plans have premiums as low as $0.||· Medicare Advantage HMOs generally require you to use doctors and pharmacies that are in the plan’s network.
· Your plan might have a yearly deductible amount that you have to pay before the plan covers your medical services. Also, plans generally charge coinsurance or copayments for medical services.
|I take prescription drugs for my health condition(s).||· A Medicare Advantage plan that includes prescription drug coverage (most of them do). Medicare Part A and Part B include limited prescription drug coverage and don’t cover most medications you take at home.
· Alternatively, you can sign up for a stand-alone Medicare Part D Prescription Drug Plan, which would work alongside your Part A and Part B coverage.
|This coverage is optional, available through private insurance companies that contract with Medicare. You’ll typically need to pay a premium and copayment or coinsurance amounts. You might also pay an annual deductible.|
|I have health problems, or expect to have them as I get older, based on my health history or family history.||A Medicare Supplement insurance plan. This type of plan may help pay for your Part A and Part B out-of-pocket costs, like coinsurance, copayments, and deductibles.||· Medicare Supplement insurance plans don’t cover prescription drugs.
· If you don’t buy a Medicare Supplement insurance plan during your Medicare Supplement Open Enrollment Period, you might not have a guaranteed-issue right to purchase a plan.
|I want certain benefits that Original Medicare doesn’t cover, like routine dental or vision services.||A Medicare Advantage plan. Many plans include benefits that Original Medicare doesn’t.||Different Medicare Advantage plans may include different extra benefits, so look at plan details carefully when shopping for a plan. For example, if you really want routine dental coverage, make sure the plan you choose has that benefit.|
|I want to see a specific doctor or specialist.||· Original Medicare (Part A and Part B), and (optionally) a Medicare Supplement insurance plan.
· A Medicare HMO plan, if your provider is part of the plan network.
· A Medicare Advantage Preferred Provider Organization (PPO)* plan, or another type of Medicare Advantage plan that may let you use a doctor outside the plan network.
|· Certain Medicare Supplement insurance plans (called Medicare SELECT plans) might require you to stay within the plan’s provider network.
· Even if your provider is in a plan network today, he or she might not be in that network next year, or in the future.
|I don’t want to be stuck with the same plan forever.||You don’t have to be. You can generally add, drop, or change Medicare health or prescription drug plans during the Annual Election Period.||If you drop a Medicare Supplement insurance plan, you might lose your guaranteed-issue right to buy such a plan later on.|
Medicare guide: more tips when shopping for a plan
No guide about Medicare would be complete without these last couple of tips:
- Let’s say you decide to enroll in a Medicare Advantage plan, or stay with Original Medicare and enroll in a stand-alone Medicare Part D Prescription Drug Plan. Did you know that Medicare rates these plans with “stars?” Five stars is the highest rating, and you can shop for five-star plans.
Normally, there are certain limited enrollment periods when you can enroll in (or change) Medicare Advantage or Medicare Prescription Drug Plans. If you decide to enroll in a five-star plan, your enrollment period is generally much longer (typically from December 8 until November 30 the following year).
- Are you going to enroll in a Medicare Advantage Prescription Drug plan or a stand-alone Medicare Part D Prescription Drug Plan? Here’s something you’ll need to know.
Not every plan covers the same inventory of prescription drugs. You may want to make a list of all your prescriptions, and check that any plan you’re considering includes that medication in its formulary. A formulary is a list of covered prescription drugs along with price-related information.
But any type of Medicare Prescription Drug Plan can change its formulary. Every fall, the plan sends you an Annual Notice of Change. Read the notice to see if any of the changes affect you. Also, a plan might change its formulary at other times of the year. The formulary may change at any time. You will receive notice from your plan when necessary.
I hope this brief Medicare guide helps you decide what type of coverage to get. If you’d like, I can walk you through the Medicare coverage options available where you live.
- To arrange a phone call with me or have me send you customized information by email, follow the links below.
- To compare plans in your area whenever it’s convenient for you, click the Find Plans or Compare Plans buttons on this page.
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether the plan will cover an out-of-network service, you or your provider are encouraged to ask for a pre-service organization determination before you receive the service. Please call the plan’s customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.