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, 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.

Vision and dental care

• Original Medicare and Medicare Supplement plans, generally don’t include extras like routine dental, vision and hearing benefits
• You’ll need to pay for these routine services out of your own pocket if you don’t have a Medicare Advantage or plan that covers them
• If extras are important to you, consider a Medicare Advantage plan, that offers the benefits you want or need

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.

Seniors and dental health

Dental health is directly tied to our overall health. And, we can be at more risk for certain oral health conditions like gum disease, tooth loss, oral cancer and dry mouth as we get older.

Having dental coverage helps you get routine care and small issues that could take a toll on your general health if left untreated. Medicare Advantage plans that offer dental benefits usually cover routine services like cleanings, X-rays and fillings. Some plans also cover dentures.

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
• Prescription drug coverage is built into Medicare Advantage plans
• Some options include routine dental care completely

Medicare Supplement (also known as Medigap)

Medicare Supplement plans pay the most of 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 home care and Medicare

Sometimes an illness requires a stay in a nursing home to help you recover. With Original Medicare, your stay in a nursing home won’t be covered unless you were admitted inpatient into a hospital for three days first. Some Medical Advantage plans have the same rule. This may be an important thing to compare when choosing a 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 network.

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

Prescription drug coverage, also known as Medicare Part D, is an additional plan you can purchase from private health insurance when you choose Original Medicare.

• Most Medicare Advantage plans have prescription drug coverage built in. You cannot enroll in a standalone Part D plan if you already have a Medicare Advantage plan. But, you'll want to check the drug lists (often called drug formularies) to make sure the drugs you know you'll need are covered and what costs you'll be responsible for.
• If you choose a Medicare Supplement plan, you will need to also purchase a standalone Part D plan. Medicare Supplement plans do not cover Part D prescription drugs.
• Keep in mind that you could pay a penalty later on if you don’t sign up for Part D prescription drug coverage when you first enroll in Medicare

Coverage gap stage or donut hole

The coverage gap stage is when you have to pay 25% of the cost of your drugs because you and your plan have paid $4,130 combined in drug costs that year. You'll pay the full cost until you reach out-of-pocket maximum of $6,550.

In the U.S. and its territories

If you choose Original Medicare only or 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, where you can get care covered by your plan 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 you need when you're traveling out of the country. 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.