Finding the Right Medicare Plan for You
You’ve done your research. You know about the Medicare enrollment process and what the different parts of Medicare cover. Even so, you’re not confident you’re ready to make a decision about Medicare.
Parts A and B (called Original Medicare) have similar coverage for most people. But the parts that are offered by private insurers — Part C (Medicare Advantage), Part D for drug coverage, and Medigap plans — vary in costs and benefits. It can be tricky to decide which suits your needs.
It might help to keep your end goal in mind: “You should go for the program that’s available to you with the right coverage and the more affordable price,” says Tatiana Fassieux, a training specialist with California Health Advocates. “You can always drop it or change plans later.”
You can also ease the process by doing some work ahead of time, and understanding what resources are available to help. That’s true whether you’re signing up for the first time or making changes to your Medicare plan.
Do Your Research
“First of all, once you start your research, take your time. This is not something you can start on the day you turn 65,” says Julia Friedman, a consulting actuary for Milliman in Brookfield, WI.
Start by asking yourself some relevant questions:
- Is it more important for you to reduce your monthly premiums or your out-of-pocket treatment costs?
- Do you want the flexibility to see any doctor or see a specialist without a referral?
- Would you be comfortable finding a new doctor if it saves you money?
- Do you plan to travel a lot or live part of the year in a different place, where you may need another doctor or hospital?
Then do a little paperwork:
- Make a list of your current medical conditions.
- Make a separate list of your current doctors and hospitals. Highlight those you’d prefer to keep using under Medicare.
- Make a third list of prescription medications you take or expect to start taking in the future.
What if I Still Have Private Health Insurance?
If you’re turning 65 but will still have private insurance through your or your spouse’s job, you might be thinking about waiving Medicare Part A hospital coverage and Part B medical coverage for now. In this case, you’ve still got some research to do.
Find out what your existing plan does and doesn’t cover and what it costs. Keep records of what you learn. Besides helping with your decision, the documentation may help you avoid late enrollment penalties when you do join Plan B, Friedman says.
Remember that once you enroll in Part B, some private health plans act as “secondary payors” to Medicare.
“This means they either won’t pay on a claim until Medicare processes it first, or they won’t pay any more than the amount Medicare would have,” says Casey Schwarz, senior counsel for education & federal policy for the Medicare Rights Center.
If you have retiree health insurance through your former employer, you may still want to enroll in Medicare. Some retiree health insurance acts as a “wrap-around,” covering the things Medicare doesn’t cover or helping pay the Medicare cost-sharing.
It’s important to check with your human resources department if you have employer or retiree health insurance before making a decision on Medicare enrollment.
Original Medicare or Medicare Advantage?
Some people like the flexibility of Original Medicare. You can:
- See any doctor who takes part in Medicare
- See a specialist without getting a referral
- Get care at any hospital that meets Medicare rules
Other people like to have their care coordinated by a health plan, as well as the additional benefits they may get with a Medicare Advantage plan. For people who’ve had insurance through an employer, a Medicare Advantage plan may seem more familiar.
Also, most Medicare Advantage plans include prescription drugs. So you don’t need a separate Part D plan the way you do with Original Medicare.