Consider these 7 things when choosing coverage

Costs [Brief]

How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.

Costs in Original Medicare

There’s no limit on how much you pay out-of-pocket per year unless you have supplemental coverage.

Costs in Medicare Advantage

Plans have a yearly limit on your out-of-pocket costs. If you join a Medicare Advantage Plan, once you reach a certain limit, you’ll pay nothing for covered services for the rest of the year. This option may be more cost effective for you.

Coverage [Brief]

How well does the plan cover the services you need?

Coverage in Original Medicare

Medicare covers medical services and supplies in hospitals, doctors’ offices, and other health care settings. Services are either covered under Part A or Part B.

Coverage in Medicare Advantage

Plans must cover all of the services that Original Medicare covers. Some plans offer benefits that Original Medicare doesn’t cover like vision, hearing, or dental.

Your other coverage

If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. If you have employment-related coverage, or get your health care from an Indian Health or Tribal Health Program, talk to your 

Benefits [Glossary]

 administrator or insurer before making any changes. 

Supplemental coverage in Original Medicare

You can add a Medigap policy to help pay your out-of-pocket costs in Original Medicare, like your 

Deductible [glossary]

 and 

Coinsurance

 .

Supplemental coverage in Medicare Advantage

It may be more cost effective for you to join a Medicare Advantage Plan because your cost sharing is lower (or included). And, many Medicare Advantage plans offer vision, hearing, and dental. You can’t use (and can’t be sold) a Medigap policy if you’re in a Medicare Advantage Plan.

Prescription drugs

Do you need to join a Medicare Prescription Drug Plan? Do you already have 

Creditable prescription drug coverage

? Will you pay a 

Penalty

 if you join a drug plan later? What's the plan’s overall star rating? What will your prescription drugs cost under each plan? Are your drugs covered under the plan's 

Formulary

? Are there any coverage rules that apply to your prescriptions? Are you eligible for a free 

Medication Therapy Management (MTM)

 program?

Prescription drug coverage in Original Medicare

You’ll need to join a 

Medicare Prescription Drug Plan (Part D)

 to get drug coverage.

  Prescription drug coverage in Medicare Advantage

Most Medicare Advantage Plans include drug coverage. If yours doesn't, you may be able to join a separate Part D plan.

 

Doctor and hospital choice

Do your doctors accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and health care providers from a 

Network

? Do you need to get referrals?

Doctor and hospital choice in Original Medicare

You can go to any doctor that accepts Medicare.

Doctor and hospital choice in Medicare Advantage

You may need to use health care providers who participate in the plan’s 

Network

. If so, find out how close the network’s doctor or pharmacies are to your home. Some plans offer out-of-network coverage. 

 

Quality of care

Are you satisfied with your medical care? The quality of care and services offered by plans and other health care providers can vary. How have Medicare and other people with Medicare rated your health and drug plan’s care and services? Get help comparing plans and providers.

Travel
Travel coverage in Original Medicare

Original Medicare generally doesn’t cover care outside the U.S. You may be able to buy supplemental insurance that offers travel coverage

Travel coverage in Medicare Advantage

Plans usually don’t cover care you get outside of the U.S.