How Do I Choose the Right Medicare Plan?

Medicare Coverage Options

When it comes time to choose your Medicare plan, it can be a confusing process. You have so many options that it can be difficult to determine which combination best covers your health needs. In addition to Medicare Parts A and B (also known as Original Medicare), there are numerous Medicare Advantage plans available, as well as Medicare Part D options (Prescription Drug Plans).

At Medicare Solutions, we help you review the different plan options and enroll in the Medicare plan that best suits your needs. If you are eligible for Medicare Advantage programs, you can enroll in an HMO, PPO, private fee-for-service (PFFS), or medical savings account (MSA) plan. If you are dissatisfied with your plan, you have the option to enroll in either a different plan or Original Medicare during the Open Enrollment Period.

If you decide to enroll in Parts A and B, you can add a Part D prescription medication plan as well as a Medigap plan. If you already have Original Medicare, Medicare Solutions can also help you review plan options for Medicare Supplement Insurance that may help pay costs not covered by Parts A and B.

Important Considerations

When choosing your Medicare plan, you need to keep several variables in mind. First, many Medicare plans are located regionally and therefore are not available throughout the United States. To determine which plans are available in your area, explore our Medicare By State page or call 1-800-328-7305.

Next, determine what you need in a Medicare plan. Some Medicare Advantage (MA) plans offer additional benefits (at an additional charge). Many MA plans can lower your healthcare costs, depending on the plan you select. Some Advantage plans, such as HMOs and PPOs, limit the doctors and providers you can use to a local network; if you use providers outside of the network, you may face an extra charge. On other plans, you are required to get a referral from your primary care physician in order to see a specialist.

Most PPO plans allow you to see a specialist without a referral, but they charge extra if you visit an out-of-network provider. In a PFFS plan, your chosen provider must accept Medicare and the plan’s terms of payment. Referrals are not necessary for specialist appointments.

Travel arrangements are another important factor when selecting a plan. If you choose a Medicare Advantage plan with a network but frequently travel outside that network, that may not be the best plan for your needs. Some MA plans include prescription drug coverage, so it isn’t necessary to enroll in a Part D plan.

Cost is also a major factor when choosing a Medicare plan. If you enroll in Original Medicare you may also enroll in a Medigap plan to help defray some of your costs.