You’ve done your research. You know about the Medicare enrollment process and what the different parts of Medicare cover. Maybe you've got 800-MEDICARE (800-633-4227) on speed dial. Even so, you're not confident you're ready to make a decision about Medicare.
Parts A and B (called Original Medicare) have similar coverage for most people. But the parts that are offered by private insurers -- Part C (Medicare Advantage), Part D for drug coverage, and Medigap plans -- vary in costs and benefits. It can be tricky to decide which suits you best.
It might help to keep your end goal in mind: “You should go for the program that’s available to you with the best coverage and the lowest price," says Tatiana Fassieux, a training specialist with California Health Advocates. "You can always drop it or change plans later.”
You can also ease the process by doing some work ahead of time, and understanding what resources are available to help. That's true whether you're signing up for the first time or making changes to your Medicare coverage.
Do Your Research
“First of all, once you start your research, take your time. This is not something you can start on the day you turn 65,” says Julia Friedman, a consulting actuary for Milliman in Brookfield, WI.
Start by asking yourself some relevant questions:
- Is it more important for you to reduce your monthly premiums or your out-of-pocket treatment costs?
- Do you want the flexibility to see any doctor or see a specialist without a referral?
- Would you be comfortable finding a new doctor if it saves you money?
- Do you plan to travel a lot or live part of the year in a different place, where you may need another doctor or hospital?
Then do a little paperwork:
- Make a list of your current medical conditions.
- Make a separate list of your current doctors and hospitals. Highlight those you'd prefer to keep using under Medicare.
- Make a third list of prescription medications you take or expect to start taking in the future.
What if I Still Have Private Health Insurance?
If you're turning 65 but will still have private insurance through your or your spouse's job, you might be thinking about waiving Medicare Part A hospital coverage and Part B medical coverage for now. In this case, you've still got some research to do.
Find out what your existing plan does and doesn’t cover and what it costs. Keep records of what you learn. Besides helping with your decision, the documentation may help you avoid late enrollment penalties when you do join Plan B, Friedman says.
Remember that once you enroll in Part B, some private health plans act as "secondary payors" to Medicare.
“This means they either won’t pay on a claim until Medicare processes it first, or they won’t pay any more than the amount Medicare would have,” says Casey Schwarz, senior counsel for education & federal policy for the Medicare Rights Center.
If you have retiree health insurance through your former employer, you may still want to enroll in Medicare. Some retiree health insurance acts as a “wrap-around,” covering the things Medicare doesn’t cover or helping pay the Medicare cost-sharing.
It’s important to check with your human resources department if you have employer or retiree health insurance before making a decision on Medicare enrollment.
Original Medicare or Medicare Advantage?
Some people like the flexibility of Original Medicare. You can:
- See any doctor who takes part in Medicare
- See a specialist without getting a referral
- Get care at any hospital that meets Medicare rules
Other people like to have their care coordinated by a health plan, as well as the additional benefits they may get with a Medicare Advantage plan. For people who've had insurance through an employer, a Medicare Advantage plan may seem more familiar.
Also, most Medicare Advantage plans include prescription drugs. So you don’t need a separate Part D plan the way you do with Original Medicare.
Tools You Can Use
Once you've got your medical and insurance information in hand, you're ready to make a deeper dive. Some online tools can make it easier.
One is the Medicare Plan Finder on the U.S. Centers for Medicare and Medicaid Services website (Medicare.gov). It lets you compare Medicare Advantage Plans and Part D plans.
This tool allows you to search and compare Medicare Advantage plans, Medicare Part D plans, and Medigap plans. You enter information into the Plan Finder, and it sorts your results by the lowest combination of premium and drug costs. You can then can sort by other things, like which plan has the covered pharmacy nearest you.
If you already have a Medicare Advantage or Part D plan, you can use the Plan Finder to compare plans. You may want to switch plans during the open enrollment period Oct. 14-Dec. 7 each year. You can also switch Medicare Advantage plans Jan. 1-March 31 if you are already enrolled in one.
Tips for Plan-Shopping
These tactics may help you once you plunge into the sea of Medicare plans:
Keep your priorities straight. Remember that your choices are not permanent. If you change your mind about a Medicare Advantage or Part D plan, you can change plans during the open enrollment periods each year. You also can switch Medigap plans, although it’s a bit more difficult.
Don’t try to plan for every medical situation imaginable. “At that point, it can get overwhelming and totally impossible to choose between plans,” Schwarz says.
Focus on the total out-of-pocket costs (including deductibles, copayments, coinsurance, maximums, and drug expenses) that you expect. Don’t get too hung up on any one expense.
Be flexible about doctors. If you go to several doctors, don’t expect all of them to be in every plan’s network. Make a priority list when you start plan-shopping, and stay flexible.
Even if your doctor is in-network with a Medicare Advantage plan, don’t assume they'll accept new Medicare Advantage patients. Call the office to ask.
Consider your drug coverage. Carefully compare your list of prescription medications against a Medicare Advantage or Part D plan’s formulary (drug list). The Medicare Plan Finder will let you enter the names of the drugs you take and tell you whether it is on the plan’s formulary. Make sure each drug is covered, then look at different costs under each plan. Also, calculate whether you could save money by switching to a generic drug or using mail-order delivery.
Check the ratings. Pay attention to the star ratings the Medicare Plan Finder gives to Medicare Advantage and Part D plans. Five stars is Medicare's top rating for how a plan performs in quality of care, customer service, and other areas.
“It’s always good to look for a five-star plan,” says Lina Walker, PhD, vice president of health security for the AARP’s Public Policy Institute.
Also, Friedman says, think about whether specialty Medicare Advantage plans, such as those for people with chronic illnesses or who qualify for Medicaid, apply to you.
If you already have a Medicare Advantage plan, always read your plan's annual notice of coverage, Fassieux says. It alerts you to any upcoming changes that might make you consider changing plans.
Should You Get Help?
Many people decide they can handle Medicare decisions on their own. But you may feel more comfortable with one-on-one expert help. You might start by calling 800-MEDICARE (800-633-4227) or with a live help chat on the Medicare.gov site.
Friedman also suggests that you tap Medicare educational resources through Medicare.gov, the Social Security Administration, and your State Health Insurance Assistance Program (SHIP).
SHIPs are state offices that offer outreach, counseling, and training on health insurance decisions like Medicare. Trained SHIP counselors can work with you one-on-one to answer any of your Medicare questions.