Turning 65 means becoming eligible for Medicare. But with all the different Medicare plans available, it can get confusing trying to choose one. Knowing the key parts of Medicare and your options can make comparing plans much more manageable. This guide breaks it down into simple steps to find a plan that fits your needs and budget.
Understanding the Parts of Medicare
Before comparing plans, it helps to know what the parts of Medicare are:
- Part A (Hospital Insurance) covers inpatient services in hospitals, skilled nursing facilities, hospice care, and some home health care services. Most people get Part A automatically when they turn 65.
- Part B (Medical Insurance) covers doctor visits, preventive care, ambulatory services, durable medical equipment, and some home health care services. You must enroll and pay a monthly premium for Part B.
- Part C (Medicare Advantage) is an alternative to Original Medicare (Parts A and B). These plans are offered by private insurers approved by Medicare. They bundle Parts A, B, and usually Part D.
- Part D (Prescription Drug Coverage) helps cover the cost of prescription medications. It is offered to everyone eligible for Medicare as a stand-alone plan or included in most Medicare Advantage plans.
Choosing Between Original Medicare or Medicare Advantage
One of the first big decisions is whether you want Original Medicare or a Medicare Advantage plan.
Original Medicare consists of Part A and Part B only. Many people with Original Medicare buy a separate Part D plan and/or a Medigap policy to help cover out-of-pocket costs.
Medicare Advantage plans (Part C) provide an alternate way to get Medicare benefits. Options like HMOs, PPOs, and PFFS plans combine Parts A, B and usually D into one plan from a private insurer. They may have different rules, costs, and restrictions depending on the plan.
When comparing plans, weigh factors like costs, benefits offered, network restrictions, prescription drug coverage, and convenience. Knowing what’s most suitable for your health needs and budget can help determine if Original Medicare or Medicare Advantage is better for you.
Comparing Medicare Part D Prescription Plans
If taking several prescription medications, the Part D Prescription Drug plan you select could make a major impact. Here are tips for comparing Part D plans:
- Use the Medicare Plan Finder tool to enter information on medications you take and find plans covering them in your area.
- Compare monthly premiums, deductibles, copays/coinsurance and the coverage stage you’d fall into based on expected medication costs.
- Check if your preferred pharmacies are in-network and if the plan requires prior authorization for your prescriptions.
- See if the plan has utilization management tools affecting drug access, like quantity limits or step therapy.
- Enroll during Medicare’s Open Enrollment Period each year (Oct 15th to Dec 7th) for the plan most suitable to your prescription needs and budget.
Supplementing Medicare with Medigap or Medicare Select
To help pay Medicare costs not covered under Parts A & B like deductibles, copays and coinsurance, many enroll in supplemental insurance known as Medigap or Medicare Select plans. These policies are sold by private health insurers.
When evaluating, expect differences in pricing structures (community-rated, issue-age-rated, attained-age rated), out-of-pocket limits, and specific benefits offered per lettered plan type. Also see if plans require answering health history questions or medical exams to qualify.
Those in good health may benefit from less expensive Medigap plans with slightly higher out-of-pocket costs, while more comprehensive plans make sense for those managing complex health needs. Shopping around is key to finding economical supplemental coverage.
Take Advantage of Resources to Compare Medicare Plans
Rather than struggle through Medicare plans alone, take advantage of free counseling services for personalized advice and comparing plan specifics:
- Contact your State Health Insurance Assistance Program (SHIP) anytime for one-on-one Medicare guidance.
- Enlist an expert Medicare insurance broker who can explain plans and identify cost savings based on your healthcare situation.
- Call 1-800-MEDICARE to speak with a representative who can answer Medicare questions and clarify plan differences.
- Use the government’s Medicare Plan Finder online to compare pricing, benefits, formularies, pharmacy networks and more.
Getting support from resources like these simplifies the entire process of selecting suitable Medicare coverage.
Making Medicare decisions doesn’t need to be confusing if you understand the basic parts and get guidance. Comparing plans is easier when you know what Medicare includes, see how options differ in pricing and benefits, and use experts to determine optimal plan selections based on your healthcare priorities and budget.