Review your needs

MAKE A CONFIDENT DECISION

Understand Your Healthcare Needs

When you understand your health care needs, you’ll be ready to review your options and you’ll have a better idea of what you’re looking for in a Medicare plan. Don’t stress. Understanding your health care needs, medical history and plans for the future takes time.

Medical

Has your health changed recently?
How do you think your health will be in the future?
How often do you visit your doctor?
Do you have a chronic condition?
Do you have any scheduled medical procedures in the next year?
How much have you paid out-of-pocket for health care this year?
What is the level of customer servuce you want to receive? Are you willing to pay a higher premium for a higher-rated carrier?

Prescriptions

Are you taking any prescription medicine regularly?
Are your meds brand or generic?
Do you have a specific pharmacy that you want to use?

Network

Do you have a specific doctor or hospital you want to use?
Do you want to be able to choose any doctor or hospital in the USA?
Do you want freedom and flexibility in your plan?

Consider these 7 things when choosing coverage

1. COSTS

Questions

How much are your premiums, deductibles, and other costs?
How much do you pay for services like hospital stays or doctor visits?
Is there a yearly limit on what you could pay out-of-pocket for medical services?
Make sure to ask questions about any coverage rules that may affect your costs.

Costs in Original Medicare

There’s no limit on how much you pay out-of-pocket per year unless you have supplemental coverage (i.e., medigap insurance).

Costs in Medicare Advantage

Plans have a yearly limit on your out-of-poket costs. If you join a Medicare Advantage Plan, once you reach a certain limit, you’ll pay nothing for covered services for the rest of the year. This option may be more cost effective for you.

2. COVERAGE

Questions

How well does the plan cover the services you need?

Costs in Original Medicare

Medicare covers medical services and supplies in hospitals, doctors’ offices, and other health care facilities. Services are either covered under Part A or Part B.

Costs in Medicare Advantage

Plans must cover all of the services that Original Medicare covers. Some plans offer benefits that Original Medicare doesn’t cover like vision, hearing, or dental.

3. YOUR OTHER COVERAGE

If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. If you have employment-related coverage, or get your health care from an Indian Health or Tribal Health Program, talk to your benefits administrator or insurer before making any changes.

Supplemental coverage in Original Medicare

You can add a Medigap policy to help pay your out-of-pocket costs in Original Medicare, like your deductible and coinsurance.

Supplemental coverage in Medicare Advantage

It may be more cost effective for you to join a Medicare Advantage Plan because your cost sharing is lower (or included). And, many Medicare Advantage plans offer vision, hearing, and dental. You can’t use (and can’t be sold) a Medigap policy if you’re in a Medicare Advantage Plan.

4. PRESCRIPTION DRUGS

Questions

Do you need to join a Medicare Prescription Drug Plan?
Do you already have a creditable prescription drug coverage?
Will you pay a penalty if you join a drug plan later?
What’s the plan’s overall star rating?
What will your prescription drugs cost under each plan?
Are your drugs covered under the plan’s formulary?
Are there any coverage rules that apply to your prescriptions?
Are you eligible for a free Medication Therapy Management (Mtm) program?

Prescription drug coverage in Original Medicare

You’ll need to join a Medicare Drug Plan (Part D) to get drug coverage.

Prescription drug coverage in Medicare Advantage

Most Medicare Advantage Plans include drug coverage. If yours doesn’t, you may be able to join a separate Part D plan.

5. DOCTOR AND HOSPITAL CHOICE

Questions

Do your doctors accept the coverage?
Are the doctors you want to see accepting new patients?
Do you have to choose your hospital and health care providers from a network?
Do you need to get referrals?

Doctor and hospital choice in Original Medicare

You can go to any doctor that accepts Medicare.

Doctor and hospital choice in Medicare Advantage

You may need to use health care providers who participate in the plan’s network. If so, find out how close the network’s doctor or pharmacies are to your home. Some plans offer out-of-network coverage.

6. QUALITY OF CARE

Questions

Are you satisfied with your medical care?
How have Medicare and other people with Medicare rated your health and drug plan’s care and services?

The quality of care and services offered by plans and other health care providers can vary.

7. TRAVEL

Travel coverage in Original Medicare

Original Medicare generally doesn’t cover care outside the U.S. You may be able to buy supplemental insurance that offers emergency care when you travel outside of the U.S.

Travel coverage in Medicare Advantage

Plans usually don’t cover care you get outside of the U.S.

source: Medicare.gov/what-medicare-covers

Understand Your Healthcare Needs