Questions to ask when choosing a Medicare plan...

COSTS 

How much are the plan's premiums, co-pays, coinsurance, and deductibles? How much will you pay for doctor visits and hospital stays? What is the plan's maximum out-of-pocket? What is the plan's minimum out-of-pocket?  

BASIC COVERAGE 

Will the plan cover the services you might need? Original Medicare (parts A & B) helps cover medical services in hospitals, doctor offices, and some other healthcare facilities. Medicare Supplements help cover the "gaps" that Original Medicare doesn't cover, like some co-pays, coinsurance, and deductibles. Most Medicare Advantage plans offer additional benefits like dental, vision, and hearing. Check the plan's EOC (Evidence of Coverage) for details.  

OTHER COVERAGE 

Will you have other medical or prescription drug coverage (for example, as a Federal employee)? Do you understand how that coverage will work with Original Medicare (A&B)? Understand your options in retirement for enrolling in a Medicare Supplement or Medicare Advantage plan. Remember you can't have both a Medicare Supplement and a Medicare Advantage plan. 

PRESCRIPTION DRUGS 

When will you need to enroll in a part D plan to avoid a penalty? Do you have "creditable" coverage at work and do you plan to retire or continue working? Are all your prescriptions included in the plan's formulary? What are the premiums, deductibles, and coinsurance? Medicare Advantage plans include part D for no additional premium. Medicare Supplement plans do not include part D, so you will need to enroll in a separate part D plan. 

DOCTOR NETWORKS 

Medicare Advantage plans are network plans (like HMOs and PPOs) though some have made their out-of-network cost & coverage the same as their in-network cost & coverage. Medicare Supplements are not network plans. Doctors who "opt out" of Medicare, may charge up to 15% more for services.  

ADDITIONAL BENEFITS  

Many Medicare Advantage plans include "extras" such as fitness center memberships, home meal delivery after hospital stays, 24/7 nurse lines, some dental, vision, & hearing benefits, and Over-The-Counter allowances so you can order non-prescription over-the-counter pharmacy items online to be delivered to your home. 

QUALITY OF CARE 

Medicare gives every Medicare Advantage plan (part C) a "Star Rating" from 1 to 5 stars every year as a measure of the quality of services provided by the plan. These annual ratings are based on over 50 healthcare categories like ease of scheduling, wait times, coding accuracy, effectiveness of care, timeliness of care, etc. Medicare Supplement plans are not given star ratings by Medicare since they are not a part of Medicare. 

FOREIGN TRAVEL 

Most Medicare Supplements and Medicare Advantage plans provide coverage for emergencies during foreign travel. Supplement Plan G covers 80% of your cost after a $250 deductible up to a lifetime maximum of $50,000. 

One Medicare Advantage plan includes "Assist America". See https://www.assistamerica.com  

USA TRAVEL 

Coverage while traveling within the United States is provided by most Medicare Supplement plans and is provided by some Medicare Advantage plans depending on plan networks. 

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SOME CAUTIONS... 

Medicare will only call you if they are calling you back. 

Medicare will never call you to enroll you in a plan, ask for your Medicare number, etc. So beware of scams. 

Medicare doesn't enroll you in supplement plans, advantage plans, or drug plans. 

Don't let anyone rush you into making a Medicare decision - take your time and consider all your options. 

If you suspect fraud or abuse of any kind, you can report it to Medicare at 1-800-MEDICARE (1-800-633-4227).