Choosing a Medicare Plan

Selecting a Medicare Plan

As mentioned in the Enrolling in Medicare page, either you can enroll directly in Original Medicare (Part A and Part B), or you can choose a Part C Medicare Advantage Plan. Each option has specific advantages, and you might want to choose one or the other depending on your situation.

Medicare Advantage Plans

Medicare Advantage Plans are like private health insurance plans that you can buy on the open market. They come with different amounts of premiums, co-pays, and coverages. You should examine the benefits and costs of each plan you’re considering, and compare to the Original Medicare costs.

For comparison purposes, the costs associated with Original Medicare are listed here.

Below are some reasons you might choose one or the other.

Some reasons you might consider a Medicare Advantage Plan

  • If you find it’s more cost effective. With Original Medicare, you have to pay premiums, co-pays, and deductibles for each part. On the other hand, many Medicare Advantage Plans cover these as part of their benefits. For example, over 80 percent of plans cover prescription drugs; with Original Medicare, your prescription drug costs depend on the drugs and pharmacy you have.

Also, Medicare does not cover all costs; as explained in the Medicare Costs page, there are co-insurance and deductibles. Many people purchase Medicare supplements (Medigap) to cover these additional costs. A Medicare Advantage Plan may be lower in cost than these supplements.

Visit this page to find and compare Medicare plans.

  • You want a cap on your total out-of-pocket costs. Original Medicare has no limit on out-of-pocket expenses; you pay your share of costs as they arise. Medicare Advantage Plans, by law, have an out-of-pocket maximum of $6,700 per year – once you reach that limit, the plan pays all covered expenses. Around half of plans have a lower limit of $3,400 or less. In 2010, average out-of-pocket Medicare costs were $4,734.
  • You want additional coverage for vision, dental, or assisted living care. Many Medicare Advantage Plans include these coverages; Original Medicare does not.

Medicare Advantage Plans do have some drawbacks, however. Here are some reasons you might consider Original Medicare instead.

Some reasons you might consider Original Medicare

  • You want the most flexibility in physicians and healthcare facilities. With Original Medicare, you can go to any healthcare provider that accepts Medicare. Medicare Advantage Plans have their own network of providers and you are more restricted. If you want the ability to see more providers, especially out of town providers if you travel a lot, you might want to enroll in Original Medicare.

Additionally, many Medicare Advantage Plans are set up as HMOs, so that you need prior authorization from your primary care provider in order to see a specialist. With Original Medicare, and plans that are set up as PPOs, you do not need prior authorization from your primary care physician to see a specialist.

Visit this page to find and compare Medicare providers.

  • If you find Original Medicare to be more cost effective. Some Medicare Advantage Plans charge monthly premiums, similar to private health insurance plans. Again, you should examine the costs of plans you are considering and compare them to each other and to Original Medicare.
  • If you are employed or retired and have health benefits through your employer. Many employee and retiree health plans are designed to supplement Original Medicare and do not work with Medicare Advantage Plans. In other cases, you might lose your employee health benefits if you enroll in a Medicare Advantage Plan. You should consult your employer before enrolling in a Medicare Advantage Plan.
  • You qualify for Medicaid or a Medicare Savings Program. If so you may have options such as premium waivers or assistance with paying co-insurance. You should contact your state’s Medicaid office for more information.

See this page to find your state’s Medicaid office.

Unsure of which route is best for you? This page can help you decide.

Ready to sign up? This page helps you get started with Medicare.