Choosing the right Medicare coverage

If you want a lower monthly premium, you’ll pay more in copays and coinsurance when you need care.

• If you are pretty healthy and don’t think you’ll need to go to the doctor very often, a plan with a lower premium and higher copays and coinsurance might make sense
• If you have a chronic condition or tend to go to the doctor more often, it may cost you less in the long run to pay a higher monthly premium and less in copays and coinsurance

Keep in mind that Medicare Advantage plans cap your annual out-of-pocket costs, so you’ll know the most you’ll ever have to pay for covered services each year. With a Medicare Supplement plan, most of your cost is the monthly premium as many of your out-of-pocket costs will be covered by the plan. With Original Medicare alone, there is no cap on costs.

Help with health care costs

If you are finding it difficult to pay for your health care costs, you may qualify for help paying your Medicare premiums, deductibles and copays/coinsurance.

See if you’re eligible to get help with Medicare costs.

Dental, vision and hearing

• Original Medicare and Medicare Supplement plans generally don't include extras like routine dental, vision and hearing benefits
• Many Medicare Advantage plans cover dental services like annual exams, cleanings and X-rays
• You'll need to pay for these routine services out of your own pocket if you don't have Medicare Advantage or a plan that covers them

Health discounts

Some Medicare Advantage plans offer discounts on gym memberships, community education and groceries.

Some Medicare Supplement plans offer gym memberships and other discounts.

Consider your general health when deciding between Medicare options. Some things to keep in mind include:

• Original Medicare pays about 80% of your healthcare costs — Medicare Supplement helps make up the difference
• Medicare Advantage plans offer an annual out-of-pocket maximum, so you'll always know the most you'll have to pay for care covered by your plan each year
• Medicare Part D prescription drug coverage is built into many Medicare Advantage plans
• Some Medicare Advantage plans include routine dental coverage

Medicare Supplement (also known as Medigap)

Medicare Supplement plans pay the 20% of cost share Original Medicare doesn't cover, such as some of your deductibles, and most of your copays or coinsurance costs when you get care. Medicare Supplement plans do not include Medicare Part D prescription drug coverage.

Skilled nursing facilities

Medicare plans differ in how they cover stays in skilled nursing facilities (SNFs). Under Original Medicare and many Medicare plans, you must have a qualifying hospital stay of three consecutive days or more for your SNF stay to be covered. UCare Medicare Advantage plans waive the three day hospital stay requirement.

Neither Medicare nor other plans include coverage for long-term or custodial care in a SNF.

With a Medicare Advantage plan, if you have a preferred doctor or other provider, it’s a good idea to find out before you enroll if your doctors and clinics are in the plan's network.

With a Medicare Supplement plan, you have no network — see any doctor nationwide who accepts Medicare.

Outpatient prescription drug coverage, also known as Medicare Part D, is not covered by Original Medicare and must be purchased separately. Always check the list of covered drugs (also called the formulary) to make sure your drugs are covered when choosing a plan.

What to know:

• You can purchase Part D coverage as a standalone plan from a private health insurer.
• You can choose a Medicare Advantage plan that includes Part D coverage. You cannot enroll in a standalone Part D plan if you already have a Medicare Advantage plan.
• Medicare Supplement plans do not cover Part D prescription drugs. You will need to purchase a standalone Part D plan.
• Keep in mind that you could pay a monthly penalty if you don't sign up for Part D prescription drug coverage when you first enroll in Medicare.
• If you're interested in spreading your out-of-pocket costs for drugs across the calendar year, consider taking advantage of the Medicare Prescription Payment Plan.

In the U.S. and its territories

If you choose a Medicare Supplement plan and need care while traveling in the U.S. or one if its territories, you can go to any doctor, clinic or hospital that accepts Medicare.

If you choose a Medicare Advantage plan and need care while traveling in the U.S, your coverage depends on your plan's network and plan details.

Travel outside the U.S.

Original Medicare does not provide coverage if you need care outside of the U.S. You're responsible for any charges for that care.

Some Medicare Advantage and Medicare Supplement plans provide coverage for emergency care when you're traveling out of the country. Some Medicare Supplement plans also include non-emergency coverage at certain percentages. Be sure to check the plan details if you're planning to travel abroad.

Ask your friends and family what choice they made and why. If their situations are similar to yours and they feel good about what they chose, you might get a good recommendation for your needs.

Medicare, your spouse and you

When you have health insurance through your employer, your whole family may be on the same plan. But when it comes to choosing a Medicare plan, what’s right for you may not be right for your spouse. You’ll each need a plan that fits your individual health needs.