| Tue, Mar 27, 2012 @ 09:00 AM

What’s Most Important to You When Choosing a Medicare Plan?

Posted by Medicare Made Clear

Whats Most Important to You When Choosing a Medicare Plan?

You want to choose the Medicare plan that best meets your needs. A little research and planning can help. One way to help write your unique Medicare wish list is to think about your needs and priorities in three areas: coverage, cost and convenience. Once you’ve made your list, you should be well-equipped to find and compare plans available in your area that meet your specific needs. 


So what do you need in terms of Medicare coverage? One way to figure this out might be to look at your past coverage and either try to match it, or use it to help identify areas of need. Here are some other things to consider when looking at your coverage needs:

  • Are you eligible for any health insurance outside of Medicare? If you’ll have group health or union coverage plus Medicare, be sure to factor that in. Maybe your additional coverage will take care of some things that Medicare won’t.

  • Which care and services do you use? Think about the care and services you’ll need, including doctor visits, prescriptions, lab tests, regular treatments, etc.

  • What is your current health status? It’s important to take an honest, objective look at your current health status to make sure all needs will be addressed. Will you need more or different care than you have had in the past?


Whether you plan to retire around the time you qualify for Medicare or not, it’s important to include a review of your budget with your Medicare planning. Consider the amount you can afford to put toward health care each month. Here are some important costs to consider when looking at your Medicare needs:

  • Premium: The premium is the amount you’ll pay each month to participate in a plan. If you’re considering a plan offered by a private insurance company—like a Medicare Advantage (Part C) plan—this amount can vary widely from plan to plan, so it might be a good idea to look at a number of plans to compare premiums.

  • Deductible: The amount you have to pay out of your own pocket before your plan will help pay some of your health care costs is called a deductible. There are high-deductible and low-deductible Medicare plans available, so be sure to shop around to get a plan with a deductible you can afford.

  • Copayment: Your copayment—also called “copay”—is the amount you pay each time you use a service, fill a prescription, etc. For example, you might have to pay $10 each time you visit the doctor. Some plans don’t have a copay and some have a high copay.

  • Coinsurance: Coinsurance is measured in percentages and refers to the percentage you pay for your health care costs and what the plan pays. For example, you might pay 20% of your health care costs and the plan will pay the remaining 80%.

 You might be tempted to focus only on the monthly premium when you compare plans. But it’s important to look at all four plan expenses listed above. A plan with a lower monthly premium might actually cost you more over the course of a year if that plan also has a large deductible or requires a higher copay for prescriptions. 

If you’re worried how you’re going to afford the Medicare coverage you need, financial help may be available. To find out if you qualify, contact Social Security at 1-800-772-1213, TTY 1-800-325-0778, 7 a.m. – 7 p.m. local time, Monday through Friday, or your state Medical Assistance or Medicaid office.



While coverage and cost are certainly important considerations when thinking about your Medicare needs, it’s also important to make sure the plans you’re researching offer the convenience and flexibility you need. It might be helpful to ask yourself questions like:

  • Do I want to continue seeing my current doctors, or visiting certain hospitals? Some plans require that you visit health care professionals or facilities within a certain network determined by the plan. If you don’t visit a provider/facility in the network, you may not receive full coverage of services.

  • What are my prescription drug needs? Drug formularies—the list of drugs a certain plan will cover—can vary from plan to plan. Many plans also require that you choose a pharmacy from within a network of pharmacies chosen by the plan.

  • Will I need coverage outside my state of residence? Be sure to take your lifestyle into consideration. If you travel a lot, be sure to look at plans that offer coverage wherever you’re going.

  • What do I value in health care coverage? It’s important to realize you don’t have to settle for coverage that’s not right for you. Some people like to keep things simple with coverage from a single plan. Others may feel most comfortable sticking with the same health insurance company they’ve dealt with throughout their life. You need to decide what’s most important to you and find the plan that fills those needs.

Putting it All Together

With your needs and priorities in mind, you can look for Medicare coverage that fits you. Learning about the four main “parts” of Medicare is a good place to start. Here’s a brief description of each part:

  • Original Medicare is offered by the government and consists of Part A (hospital coverage) and Part B (medical coverage).

  • Medicare Advantage plans, also called Medicare Part C, are offered by private insurance companies and include all the coverage of Original Medicare plus additional benefits, like dental and wellness coverage.

  • Medicare Part D is prescription drug coverage and is available as a standalone plan or included in a Medicare Advantage plan.

Medicare Supplement Insurance plans—also called “Medigap”—are labeled “A” through “N” and help pay for some of the expenses Original Medicare won’t cover. They are not considered a “part” of Medicare. The coverage and costs for Parts A and B are set by Medicare and are the same for everyone. Coverage and costs for Medicare Advantage plans, Part D prescription drug plans and Medicare Supplement Insurance plans can vary widely by plan and region.

One helpful resource to find all types of plans in your area is the Medicare.gov plan finder. You simply enter some basic information—like your ZIP code—and you’ll see a list of plans available in your area. For each plan, you’ll get a summary of coverage, premiums, deductibles, copays, estimated annual costs and more. Then you can select the plans you’re interested in and compare them side-by-side. If you find a plan you like, you can even enroll online.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear call Medicare Made Clear at 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.


Medicare Basics: MedicareMadeClear.com

Your Medicare Coverage Choices: Medicare.gov

Medicare and You: Medicare.gov

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