Getting Right Medicare Plan For You
Jessica Fox Last Updated On: September 17, 2021

How to Choose the Best Medicare Plan for You ?

How to choose medicare plan

Sometimes having too many health insurance options can be overwhelming—just look at Medicare!

Since there is no “one plan fits all,” having a variety of Medicare plans to choose from means there’s something for everyone. The bad news is that trying to figure out which Medicare plan works best for your needs can be challenging—but don’t worry: we’ve got you covered. 

Read on, and we’ll share some pointers on how to find the right Medicare plan for you.

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Determining Your Needs

The first step to figuring out which Medicare plan is best for you is determining what you need out of your health insurance. These are some of the questions you should ask yourself:

  • In-Network Care: Do your regular hospital, physicians, and labs accept Medicare Advantage or Original coverage? Advantage beneficiaries are restricted to an approved list of in-network physicians if they want their healthcare costs covered, while Original recipients can go anywhere Medicare is accepted.
  • Do You Travel: If you plan on travelling outside the United States, Original Medicare with Supplemental (Medigap) coverage will help pay for your out-of-country medical costs.
  • Risk Tolerance: Based on your current state of health, do you foresee yourself needing a lot of medical treatment? If so, are you alright with paying a small or large portion out-of-pocket? Original Medicare doesn’t limit how much you’ll pay out-of-pocket, so if you require frequent medical attention, you may want Supplemental coverage to offset the expense. In comparison, Advantage does have an out-of-pocket limit.
  • Reassurance: If you’re the sort of person who needs peace of mind that you’re fully covered against whatever life throws at you, you’ll likely benefit from comprehensive coverage — Medicare with Supplemental coverage or Medicare Advantage. 

How To Choose The Best Medicare Plan?

Once you’ve decided on your needs, the next step is finding the perfect Medicare plan for you.

Original Medicare Or Medicare Advantage: The biggest decision you’ll have to make is determining if you’d like Original Medicare or Advantage.

  • Original Medicare offers Part A (hospital care) and Part B (outpatient care like doctors appointments, lab work, and preventative care) protection. You’re also eligible for Medigap or Supplemental coverage (including Part D prescription drug coverage) for less out-of-pocket expenses. Some other features of Original Medicare are:
    • You can use any physician accepting Medicare; you’re not limited to in-network providers.
    • Part A costs are usually covered, while Part B is based on your income.

You’ll have to pay coinsurance, premiums, and deductibles; however, Medigap can help absorb these costs.

  • Medicare Advantage offers Part A, Part B as well as additional benefits such as prescription, dental, vision, and hearing coverage and even fitness club memberships. You are not eligible for Medigap Supplemental plans. Some additional Medicare Advantage considerations are:
    • You have to see in-network providers, which is problematic if you want to select your own doctor.
    • It offers low-cost premiums, deductibles, coinsurance, and copays.
    • There is an annual limit to out-of-pocket expenses.
    • Medicare Advantage is offered by private insurance companies and regulated by the federal government
  • Drug Coverage: The next step is deciding on your prescription drug coverage. If you choose Original Medicare, you can purchase drug coverage with Plan D, while Advantage plans have built-in drug coverage. Here are some tips to help you figure out which plan type is better for you:
  • Drug Formulary: Plan D comes with a list of generic and brand-name prescription drugs offered by your Plan D and is subject to change annually.
  • Cost: Premium costs are based on your earnings. The cost breakdown when it comes to paying for your prescriptions is:
    • Deductibles: Vary but have an annual max cap.
    • Copay/Coinsurance: You’ll pay a copay (e.g., $20) or coinsurance (e.g., 10%) for each prescription filled. 
    • Tiered Pricing: You’ll pay more for brand-name prescriptions and less for generics. 

Supplemental coverage is only available to Original Medicare beneficiaries as a way to save on out-of-pocket medical expenses. Your premiums are set based on where you live (state regulation), the Medigap plan you select and your age. If you’re keen on getting Medigap, be sure to lock into a plan during initial enrollment as you’re guaranteed an issue (which usually also means cheaper premiums); if you don’t, you could be denied coverage.

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How To Choose Which Medicare Plan Is Best

Ultimately the most important thing is attaining Medicare, so you aren’t on the hook for avoidable out-of-pocket medical expenses. There is no denying how overwhelming it is comparing all the pros and cons for each Medicare plan. But if you want a future where you don’t have to worry about paying for unexpected doctor visits, then it’s in your best interest to investigate all your options.

The first step to finding the best Medicare plan for you is recognizing what you need out of your Medicare coverage. Once you know what you need, like affordable coverage that you can take across the globe, only then can you identify the perfect Medicare plan for you!

 

Jessica FoxJessica Fox has been a freelance writer for five years, with a specialty in health, wellness, and insurance. During this time, she’s written for some of the biggest B2B and B2C brands from around the world. Jessica is also the mother of two young daughters and loves coffee, writing, and working out.