Medicare offers critically important health insurance for older adults. Once you reach age 65, you can enroll – but trying to understand your new coverage, your new options, and all that Medicare has to offer can be confusing. That’s why it’s so important to do your research about Medicare before open enrollment arrives each year. You can search online to learn about Medicare and all of its options.
Whether you’re new to Medicare or are simply double-checking your coverage during open enrollment, it’s a good idea to consider your needs. You want to make sure your Medicare plan actually covers what you need the most. And the best way to do that is by searching online for the latest information on Medicare.
Before you choose a new plan or make any changes to your current plan, make sure to consider the following six factors. These details can help you secure the right Medicare coverage for your health and your budget.
1. The Type of Coverage You Need
Your Medicare coverage determines some of the most important factors that affect your healthcare. The coverage you choose determines everything from the doctors you can see to your premium costs to your out-of-pocket costs. That’s why you need to make sure you opt for coverage that includes the services you need above all else.
You have two types of coverage available under Medicare:
- Original Medicare, or Medicare Parts A and B.
- Medicare Advantage (Part C), a plan that covers the same services as Original Medicare but may also offer additional coverage.
Make sure to look into the details of what’s covered under each of these plans. You’ll also want to consider any other insurance coverage you might have, like a health insurance policy provided by your employer. These plans can work alongside Medicare and may be something you want to keep. Or, you may find that you’re perfectly satisfied with Medicare coverage alone.
2. If You Need to Add Supplemental Coverage
You do have the option to increase your coverage under Medicare by adding supplemental insurance. You can purchase Medicare Supplemental Insurance, or Medigap, from a private insurance company.
Medigap plans help fill in the gaps of Original Medicare. While Original Medicare covers quite a lot, it can leave you with extra costs like copayments, coinsurance, and deductibles. A Medigap plan can help eliminate some of these costs or pay for a portion of them.
In order to get a Medigap plan, you must be enrolled in Original Medicare (Part A and Part B). Keep in mind that you will have to pay a monthly premium for a supplemental plan, and you may still have additional healthcare costs that you have to pay out of pocket.
3. Whether or Not You Need Prescription Drug Coverage
One area of healthcare you might be surprised to realize isn’t wholly covered under Medicare is the cost of your prescription drugs. For some individuals, Medicare’s limitations on the amount of prescription drug costs leaves them paying significant out-of-pocket costs.
Make sure to assess how much coverage you need for your prescription medications. If you don’t think Medicare will be able to fully cover the costs, you can join a Medicare Prescription Drug Plan (Part D). With a Medicare Prescription Drug Plan, you’ll be covered for many medications and lower your out-of-pocket costs.
You can also choose to enroll in a Medicare Advantage plan, as many of these plans include prescription drug coverage. If you already have a Medicare Advantage plan but it doesn’t include this critical coverage, you’re also eligible for a Part D plan.
Make sure to look carefully at all of the details of your prescription drug coverage before making changes. There may be limitations and exclusions, or you may discover your plan has coverage rules that apply to your prescriptions. It’s a good idea to go over the prescriptions you take regularly to ensure they’re covered either under your current plan or a Part D or Medicare Advantage plan.
4. Your Doctors and Local Hospitals
Don’t assume that your doctor will accept Medicare. Every doctor accepts different types of health insurance and different policies or plans – and the same goes for Medicare. Some doctors will welcome Medicare patients, but others will not.
Check with your doctors to see if they will accept the Medicare coverage you’re planning to get. Will they accept Original Medicare? What about the Medicare Advantage plans you’re considering? Will they accept Medigap insurance if you need to use it?
You can also check the details of your Medicare plan and coverage to find out if you have restrictions or limitations. For example, Original Medicare allows you to see any doctor who accepts Medicare. If you have a Medicare Advantage plan, you may be required to see doctors and go to hospitals that participate in the plan’s network. You may be able to see doctors who are outside of the network at a higher cost.
Get the details about your doctor and hospital coverage before you make any changes. That way, you’ll know if you can keep seeing your current doctor or if you need to find a new doctor.
5. If You Plan to Travel
Seniors who travel outside of the U.S. will also want to take a look at their options and coverage under Medicare. Both Original Medicare and Medicare Advantage plans generally don’t cover any medical care you receive outside of the U.S. – and that can be problematic if you’re a frequent traveler.
However, you may be able to purchase additional coverage or a separate plan that does cover international healthcare costs. You’ll need to search for these types of plans, and you’ll want to make sure to read the fine print so you know exactly what’s covered.
6. Your Costs
Lastly, and perhaps most importantly of all, you’ll want to determine how much your Medicare choices will cost you. While ensuring that all of your health needs are covered is critical, the amount you’ll pay out of pocket is also very important, especially if you live on a fixed income.
Many people only think about premium costs when it comes to health insurance. However, Medicare is a bit more complex. You may pay nothing at all when it comes to your premiums – even Medicare Advantage plans are available with $0 premiums. But there are other costs you’ll be responsible for.
Look at the following potential costs for Original Medicare, Medicare Advantage, Part D, and Medigap plans you’re considering:
- The monthly premium.
- Copayments for doctor’s visits and hospital stays.
- The annual deductible.
- Prescription drug copayments.
- Any yearly limit on out-of-pocket costs.
For Original Medicare subscribers, there is no limit on what you’ll pay out-of-pocket each year. For Medicare Advantage subscribers, you may reach a limit for these expenses. Make sure to double-check your plan, as every Medicare Advantage plan is different.
If you’re worried about paying too much, you can always search for new Medicare coverage. You can compare plans offered under Medicare Advantage and Medigap coverage, and you can find one that meets your healthcare needs and your budget.