How to choose the right Medicare plan for you

Navigating Medicare plans and coverage options can feel like a maze. With so many choices—Medicare Advantage, Medigap (Medicare Supplement), Medicare Part D Prescription Drug plans, and original Medicare—it’s easy to get lost. But don’t worry, we’ve got your back!

Who Does Medicare Cover?

Medicare is the federal health insurance program for people who are 65 or older. It also covers younger people with disabilities, End-Stage Renal Disease (ESRD), or Lou Gehrig's disease (ALS). For most people, the eligibility window to sign up for Medicare coverage starts three months before they turn 65 (including their birth month) and ends three months after they turn 65.

Types of Medicare Coverage

Original Medicare (Medicare Parts A and B)

Original Medicare consists of Part A and Part B coverage. Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health services. Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services. There are no premiums for Part A for most people, but you do pay a monthly premium for Part B.

Prescription Drug Plans (Medicare Part D)

Medicare prescription drug plans are optional coverage available to people with Original Medicare coverage, as well as other cost plans, private fee-for-service plans, and Medical Savings Account plans. Many Medicare Advantage plans (Medicare Part C) include prescription drug coverage as part of the all-in-one plan offering.

Medicare Advantage (Medicare Part C)

Medicare Advantage plans are offered through Medicare-approved private insurance companies and typically combine Parts A, B, and D coverage into a single plan. These plans may also include additional benefits. While there can be several added benefits to these plans, they often have a more limited network of doctors and hospitals.

Medicare Supplement Insurance (Medigap)

Medicare Supplement insurance, or Medigap coverage, is extra insurance offered by private insurance companies. It helps supplement Original Medicare coverage by covering out-of-pocket expenses.

Tips For Comparing Medicare Plans

Comparing Medicare plans can feel like a daunting task, but with a few tips, you can make the process much smoother. Here are some key things to keep in mind:

• Take Your Time to Shop Around: Don't rush the decision. Compare different plans to see which one best fits your needs. Plan details can change yearly, so it's worth reviewing your options regularly.
• Look Beyond Monthly Premiums: While a low premium might seem attractive, consider other costs like deductibles, copays, and coinsurance. Sometimes a plan with a higher premium might save you money in the long run.
• Check Medication Coverage: If you take prescription drugs, ensure the plan covers your medications. Look at the plan's formulary (the list of covered drugs) to see if your prescriptions are included.
• Confirm Your Doctor's Network Participation: Make sure your preferred doctors and hospitals are in the plan's network. Seeing out-of-network providers can lead to higher out-of-pocket costs.
• Understand the 5-STARS Rating System: Medicare rates plans on a scale of one to five stars based on quality and performance. A higher-rated plan might offer better service and coverage.
• Get Help with Your Decision: Use resources like the Medicare Plan Finder tool on Medicare.gov, or seek advice from a licensed insurance agent or a State Health Insurance Assistance Program (SHIP) counselor.

Choosing the right Medicare plan involves understanding your health needs and comparing the different options available. Take your time to review each plan's benefits and costs to find the one that best fits your needs. Good luck, and happy enrolling!