When age 64 rolls around, all of a sudden you’re inundated with Medicare information. The problem is, it all seems so complicated and it’s hard to know which Medicare option is best. “The point of Medicare is to keep costs down for seniors,” says Tanya Feke, M.D., an urgent care physician in New Hampshire and author of Medicare Essentials: A Physician Insider Explains the Fine Print. “You want to get a plan that covers the services you anticipate you are going to need.” How to do that? Before you make any decisions, consider these five things, says Medicare expert Diane Daniels, author of The Medicare Survival Guide. Once you know the answers to these questions, your choice will be easier.
Do you want to keep your doctor?
If you’ve had your doctor for years or keeping the same doctor is critical, consider enrolling in Original Medicare plus a Medicare Supplement Plan, both of which cover ANY doctor that accepts Medicare patients. If you’re leaning towards enrolling in a Medicare Advantage Plan, carefully check the plan details to make sure your doctor is in-network. “Find out what plans your doctor is contracted with,” says Daniels of Medicare Advantage. “If your doctor only takes three plans, you have to choose from one of them.” But be careful, she advises. “That doctor could decide to throw away that contract, or the panel of doctors could change at any time.” In that case, you’ll have to stay on your plan and choose a new doctor.
What is your health history?
Are you someone who sees a doctor once a year, or do you have a chronic illness and are hospitalized often? “If you have health issues and hospitalization is a concern for you, keep in mind that Medicare Part B only pays for 80 percent of your costs, with no spending cap, which means you’ll be paying the additional costs unless you have supplemental insurance,” says Daniels. If you’re in good health, Original Medicare or a Medicare Advantage plan may work equally well for you. But before choosing a Medicare Advantage Plan, make sure your doctors and hospitals are in-network in case health issues arise and you need hospitalization.
What is your financial situation?
How much money you make matters—the higher your income, the higher your Original Medicare premiums. Before choosing a Medicare plan, “go over your budget and first look at how much you’re currently spending on healthcare,” says Dr. Feke. “Factor in drugs, doctor visits, hospital stays, and anything else health-related.” Your goal is to figure out how much you can realistically spend on healthcare.
Are you on several medications?
When shopping for a Prescription Drug Plan, make sure that your exact medications are covered under the plan you’re considering. Check the plan’s formulary (the list of covered medications) before you make any decisions. Also, make sure your pharmacy is in the plan’s network.
Are you still working?
If you are still working and you’re getting health coverage through your employer, sit with your company’s human resources person to look at your current coverage, and then compare it to Medicare’s benefits and the cost involved. Do you have a high deductible for the plan you’re on now? Are you paying a monthly premium and also have a deductible? You’ll want to cost out all your options:
- Your current plan provided by your employer
- Original Medicare, plus a Prescription Drug Plan
- Original Medicare, plus a Prescription Drug Plan, plus a Medicare Supplement Plan (to cover the 20% that Original Medicare doesn’t cover)
- A Medicare Advantage plan (which should include a prescription drug plan)
If you have additional questions, see our complete Guide to Medicare.