Which Medicare Plan is Right for Me?

Parcheesi or Monopoly, Trivial Pursuit or Scrabble, checkers, or chess? These choices are easy. Picking the right Medicare plan? That can be hard.

Do you want Original Medicare (Parts A and B)? Should you add prescription drug coverage (Part D)? What about Medigap insurance? Or is Medicare Advantage (Part C)—which combines Parts A, B, and D—better for you? Sometimes, it might feel like a roll of the dice!

Before you get lost, take a step back. You want to pick a plan right for you. So, think about what your life will look like after 65. You can start by asking these five questions to figure out your next move.

1. Will I be on a fixed income?

For most older adults, health care is more expensive than anything else, except for their homes. The cost of a Medicare plan can depend on many things. But:

• If you choose Original Medicare (Parts A and B): Expect to pay a premium and a deductible, then 20% of all fees. There’s no yearly limit on what you pay out of pocket. Additional Medicare Supplement Insurance (Medigap) can help. You’ll pay a private insurance company a separate monthly premium for a Medigap plan.
• If you add in Prescription Drug coverage (Part D): You pay another premium. The cost of your medicine depends on which plan you choose and other factors. Original Medicare doesn’t include prescription drug coverage.
• If you choose Medicare Advantage (Part C): You may have a monthly premium in addition to the Part B monthly premium, you pay to Medicare. You will also pay copays and meet a deductible for services. However, there’s a set amount you’ll never go over during the plan year. It’s called the annual out-of-pocket maximum and each plan’s set amount is different.

2. Do I want to see a specific doctor?

For many people, the answer is yes.

• Original Medicare (Parts A and B): You can go to any doctor or hospital that takes Medicare anywhere in the U.S. Make sure they accept Medicare before scheduling your appointment.
• Medicare Advantage (Part C): In many cases, you can only use doctors and providers who are in the plan’s network for non-emergency care. Some plans offer non-emergency coverage out of network — typically at a higher cost. You may also need to get a referral from your primary care doctor to see a specialist.

3. Do I care about having my eyes, ears, and teeth checked?

Medicare Advantage may be a better choice. Many Medicare Advantage plans offer added benefits that Original Medicare doesn’t cover. And included with the plan’s monthly premium amount.

4. Do I plan to travel?

Does your retirement include crossing the U.S. in an RV? Or will you be visiting grandkids out of state?

• Original Medicare (Parts A and B): You’re covered if the provider accepts Medicare. Again, be sure and call before scheduling an appointment.
• Medicare Advantage (Part C): Your plan may include in-network doctors and hospitals where you’re traveling within the U.S. Or out-of-network doctors may be available at a higher cost. You also have emergency and urgent care outside your network. Copays or coinsurance may apply. But be careful: If you travel outside your plan’s service area for more than six months in a year, you may be automatically disenrolled from your plan.

Traveling outside the U.S.?

• Original Medicare (Parts A and B): Typically, does not cover care outside the U.S., except for certain circumstances. Individuals may be able to buy a Medicare Supplement Insurance (Medigap) policy that covers emergency care outside the U.S.
• Medicare Advantage (Part C): Plans generally do not cover medical care outside the U.S., except for certain circumstances. Some plans may offer a supplemental benefit that covers emergency and urgently needed service when traveling outside the U.S. Medicare Advantage members should always check with their plan’s Member Services to confirm what’s covered.
• Be aware: Neither Original Medicare nor Medicare Advantage cover routine care outside the U.S.
• Purchasing a separate travel medical insurance may be the way to go.

5. What if I don't know what I want?

We get it. It’s hard to decide, especially when your needs might change.

Figuring out these questions during this stage of life is harder than playing the game of Life! If you need help, our licensed insurance agents are always ready to chat with you. You can count on us—and that’s one thing that will put you ahead of the game.

MDDB483 1/2024