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How to Select a Medicare Health Plan

How to Select a Medicare Health Plan

In Medicare, you can choose different ways to get the services covered by Medicare. Depending on where you live, you may have different choices.

  1. In most cases, when you first get Medicare, you are in Original Medicare.
  2. You may want to consider a Medicare Prescription Drug Plan to add prescription drug coverage.
  3. You may want to consider a Medicare Advantage Plan (like an HMO or PPO) that provides all your Part A, Part B, and often Part D prescription drug coverage.
  4. Or, if you choose Original Medicare, you may want to consider a Medicare Supplemental Policy (Medigap).

You make a choice when you are first eligible for Medicare. Each year you can review your health and prescription needs and switch to a different plan in the fall. There are things you should consider to help you meet your needs.

Things to consider

  1. Cost
    • What will you pay out-of-pocket, including premiums, deductibles, and other cost-sharing (copays or coinsurance)? Some plans help pay your share of the cost (coinsurance, copayments, or deductibles) of Medicare-covered services. To get this kind of help, you have two main options: 1) Medicare Advantage Plans or 2) the Original Medicare plus a Medicare Supplemental Policy (Medigap).
    • Check the Plan Comparison and Plan Detail reports in this tool to see plan costs.
  2. Benefits
    • Are extra benefits and services, like eye exams, dental benefits, hearing aids, or emergency health care outside the United States covered? (These may be covered by some plans.)
    • Does the plan include all Medicare benefits (Part A and Part B) and prescription drug coverage?
    • Check the Plan Comparison and Plan Detail reports in this tool to see plan benefits.
  3. Doctor and Hospital choice
    • Can you see the doctor(s) you want?
    • Do you need a referral to see a specialist?
    • Can you go to the hospital you want?
    • Do you pay less to go to certain doctors or hospitals?
    • Check the Plan Comparison and Plan Detail reports in this tool to see how much choice a plan offers and whether you need referrals.
    • Contact the plan for more information about their doctors and hospitals.
  4. Convenience
    • Where are the doctor’s offices?
    • What are their hours?
    • Is there paperwork?
    • Are they accepting new patients?
    • Do you spend part of each year in another state? Will the plan cover you there?
    • Contact the plan for more information about their doctors and hospitals.
  5. Prescription Drugs
    • Are your drugs covered under the plan's formulary (list of covered drugs)?
    • What will your prescription drugs cost under the plan?
    • What is the premium for the plan?
    • What is the deductible for the plan?
    • Does the plan provide some coverage in the gap?
    • Check the Plan Comparison and Plan Detail reports in this tool, or go to the Medicare Prescription Drug Plan Finder, get formulary information.
  6. Pharmacy Choice
    • What pharmacies can you use?
    • Check the Plan Comparison and Plan Detail reports in this tool, or go to the Medicare Prescription Drug Plan Finder, get pharmacy information.
  7. Quality and Performance
    • Quality of Care and performance varies among plans, doctors, hospitals, and other health care providers. Giving good quality health care means doing the right thing, at the right time, in the right way, for the right person – and getting the best possible results.
    • Check the plan ratings in this tool.