What to Look for in a Medicare Plan
- Good Pharmacy
- 14 minutes ago
- 3 min read
Are you about to turn 65 and are eligible for a Medicare plan? Trying to choose a health plan is a big decision and not necessarily an easy one. There are important things to consider, which is why we are here to help you understand the various Medicare plans and your options going forward.
What is Medicare?
Medicare is the United States’ health insurance program for people who are 65 years or older. If you have permanent kidney failure or receive disability benefits, you may also qualify. ¹
Choose The Right Medicare Plan for You
There are two main Medicare coverage options that you can choose from, which are Original Medicare and Medicare Advantage. ²
Original Medicare is a plan that allows you to pay for services as you get them. When you get a service that is covered by your insurance, Medicare pays part of the cost, and you pay for your share. You can also see any doctor or hospital within the United States that takes Medicare. This plan includes Hospital Insurance (Part A), Medical Insurance (Part B), and you can add the Medicare Drug Coverage option (Part D).
If you choose the Original Medicare coverage and want to add drug coverage, you can join a separate Medicare drug plan. This drug plan is optional but can cover a variety of brand-name and generic prescription drugs, with each plan having a list of covered drugs that can vary in cost and specific drugs covered.
Medicare Advantage or Part C is a plan that you join by using a Medicare-approved plan from a private company that offers an alternative to Original Medicare. You can use doctors who are within your plan’s network. This plan includes Hospital Insurance (Part A), Medicare Insurance (Part B), and Medicare Drug Coverage (Part D.)
Compare Policies and Prices
It’s important to review your specific plans, policies, and pricing before enrolling in anything. If you choose to go with Original Medicare (Parts A and B), your costs will be the same as everyone else enrolling in this plan. As for Medicare Advantage, you’ll have more plan options to choose from and consider, with each of them offering different coverage options. That’s why it is important to shop around when choosing to go with a Medicare Advantage plan.
For those who want to compare pricing to specific plans and coverage options, you can always go to the Medicare.gov website and explore the different Medicare options that are available for you in your state. ³
Select a Plan and Enroll
Now, after you’ve done your research about your policies, coverages, and costs, it’s time to select your plan and enroll in it. The best time to enroll in a Medicare plan is during the Open Enrollment Period, which is October 15th to December 7th.
The Open Enrollment Period is available for those who want to join, drop, or switch to another Medicare Advantage Plan with or without drug coverage (or add or drop drug coverage). Those who want to switch from Original Medicare to a Medicare Advantage plan or the other way around, switching from Medicare Advantage to Original Medicare. You can also join, drop, or switch to another Medicare drug plan if you’re on Original Medicare. ⁴
These changes to your Medicare plans during Open Enrollment will go into effect on January 1st of next year, but the plan must get your enrollment request by December 7th. Which is why switching, dropping, or joining is highly encouraged during this specific period.
Where Can I Get Questions Answered?
When you have questions about Medicare, there are a few places and people you can ask those questions to. No matter if your questions are about what medications are covered, the specific costs on a certain plan, or even how it will affect your team of healthcare professionals, there are resources to help. ⁵
The first person who can help to answer your questions is your pharmacist at your local pharmacy. They’re able to answer any questions that you may have about enrolling in a new plan, medication costs, and how it will affect your care at that specific pharmacy. If the pharmacy offers, you can always set up a free open enrollment review, which allows you to ask all the questions possible, with a licensed healthcare professional.
If you can’t get in to see someone to discuss your questions, you can always talk to someone on Medicare.gov, which is the official government website that provides information about Medicare and Medicaid programs. ⁶ Another program that offers free one-on-one counseling is the State Health Insurance Assistance Program (SHIPs), and they can offer local Medicare resources from trained volunteers. ⁷
References:
2. https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options
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