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How to Make Sure You Have the Right Medicare Plan for You


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Maybe you’re new to Medicare and facing a variety of Medicare plan options. Or perhaps you have a Medicare health plan and you’re not sure if you could get better coverage. Either way – it’s important to step back now and then and evaluate your situation. Let’s run through the various Medicare plan and coverage options and how they might match up with your needs.

Matching Medicare plan options with your health needs

Here’s a table that lists the more common Medicare plan options and some things to consider about each. These Medicare plan options are briefly described below the table.

Type of coverage Description Quick facts Other considerations
Original Medicare (Part A) Hospital insurance Many people are enrolled automatically when they qualify for Medicare. Most people don’t pay a premium.*

Deductibles, coinsurance, and/or copayments may apply.

Original Medicare (Part B) Medical insurance Many people are enrolled automatically when they qualify for Medicare. Most people do pay a premium.

You can delay enrollment if you’re covered by other insurance, such as an employer-based plan.

Deductibles, coinsurance, and/or copayments may apply.

Doesn’t cover most prescriptions you’d take at home – limited to certain prescription drugs administered in outpatient settings.

Medicare Supplement insurance Supplemental health insurance that works alongside Medicare Part A and Part B May pay for Part A and Part B out-of-pocket costs

 

If you have many doctor visits or hospitalizations – or you expect to – this type of insurance might save you money.

You’ll likely pay a monthly premium. Some plans might have deductibles.

Stand-alone Part D Medicare Prescription Drug Plan Medicare prescription drug coverage May help pay for your prescriptions Works alongside your Medicare Part A and/or Part B coverage.

You’ll likely pay a monthly premium. Deductibles and coinsurance and/or copayments may apply.

Check the plan’s formulary to see if it covers your prescriptions:

·      Before you sign up

·      Every fall when the plan sends you its Annual Notice of Change

Medicare Advantage plan Alternative way to get your Medicare Part A and Part B benefits May help pay for your prescriptions.

May include extra benefits, like routine dental services.

Many plans require you to use doctors and pharmacies in the plan’s network.

Some plans have premiums as low as $0 (but you must keep paying your Medicare Part B premium).

Most plans include prescription drug coverage – but not every plan.

Check the plan’s formulary to see if it covers your prescriptions:

·      Before you sign up

·      Every fall when the plan sends you its Annual Notice of Change

*You generally don’t have to pay a premium for Medicare Part A if you’ve worked at least 10 years while paying Medicare taxes.

Types of Medicare plan options

Here’s a quick summary of Medicare plan and coverage options.

Original Medicare is the government health insurance program for those who qualify due to age (65 years or older) or disability. It’s made up of Part A and Part B.

  • Medicare Part A is hospital insurance. It typically covers inpatient hospital stays, hospice care, skilled nursing care, and limited home health-care services.
  • Medicare Part B is medical insurance. Some of the services and items covered may include: doctor visits, preventive care such as certain shots, some lab test and screenings, some medical equipment and supplies.

Medicare Supplement insurance is separate insurance you can buy from private insurance companies. It’s designed to help pay the out-of-pocket expenses from Medicare Part A and Part B, such as coinsurance and copayments.

Stand-alone Medicare Part D Prescription Drug Plans may cover medications, although costs such as a monthly premium, an annual deductible, and copayments may apply. These plans are offered by private, Medicare-approved insurance companies.

Medicare Advantage plans deliver your Medicare Part A and Part B benefits (except hospice care, which Part A covers). Under Medicare Advantage, you’re still in the Medicare program, but your benefits come to you through a private, Medicare-approved insurance company.

The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

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eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.