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There’s a Lot to Consider

When choosing your Medicare plan, there’s more to weigh than price point. Look at whether your plan covers the services you need most, how it works with other insurance you might have, prescription coverage, the quality of care it covers, and what choices you have in your doctors and hospitals.

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You May Not Have the Plan You Need

There are four parts to Medicare coverage:

  • Part A: Hospital coverage
  • Part B: Medical/outpatient coverage
  • Part C: Medicare Advantage -- plans that provide part A and B benefits through a private company, though there may be some exclusions
  • Part D: Prescription coverage
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When You Can Shop

You only have 2 months to join, switch, or drop a plan: Oct. 15 to Dec. 7. Your new coverage will begin Jan. 1 of the next year. If you’re enrolled in Medicare Advantage, you can switch plans or switch to original Medicare from Jan. 1 to March 31.

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New Coverage May Be Added

The number and type of Medicare Advantage plans available is higher than ever. There are more special needs plans and better insulin coverage. And more firms are offering Medicare plans, giving you more options for shopping around.

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You Require a Special Needs Plan (SNP)

You might need an SNP if you have a chronic disease or have a condition that requires the level of care a medical facility provides for at least 90 days or more. You may also qualify for a dual-eligible SNP if you’re eligible for both Medicare and Medicaid. 

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Medicare Advantage May Be for You

When you enroll in a Medicare Advantage plan (Medicare Part C), the company you enroll with becomes your primary source of health insurance. These plans can be HMOs, PPOs, private fee-for-service plans, or special needs plans. Most Medicare Advantage plans also have prescription coverage.

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A Trial Period Could Help You Decide

The first year you have Medicare Advantage, you get a one-time trial period. During this year, you can switch back to Original Medicare and also enroll in a Medigap plan (Medicare supplement), as well as a Part D Prescription Plan if your Medicare Advantage plan covered prescriptions.

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There’s an Easy Comparison Tool

You can compare plans based on Medicare’s 5-star rating system created from member satisfaction surveys, plans, and health care providers. Medicare updates these ratings each fall for the following year.

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You Can Pair Medicare With Other Coverage

If you use other insurance alongside Medicare, something called “coordination of

benefits” rules decide which insurance pays first. The “primary payer” pays what it owes on your bills first. Then you or your health care provider sends the rest to the “secondary payer” to pay.

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You Might Need It Before You Turn 65

Know if you qualify: If you’re under 65 and receive Social Security Disability Insurance for at least 24 months, you’re eligible for Medicare. People under 65 who have end-stage renal disease or ALS qualify right away.

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SOURCES:

Medicare.gov: “Consider these 7 things when choosing coverage,” “our Medicare coverage choices,” “Joining a health or drug plan,” “How Medicare Special Needs Plans (SNPs) work,” “Medicare Advantage Plans,” “5-star special enrollment period,” “Your Guide to Who Pays First.”

Kaiser Family Foundation: “Medicare Advantage 2022 Spotlight: First Look,” “Medicare's Role for People Under Age 65 with Disabilities.”

medicareresources.org: “How do I change my Medicare coverage?”