Choosing A Medicare Plan That’s Right For You

Choosing medical coverage is a complex process with many moving parts. Choose the wrong plan and even the most basic of services or uncovered specialty services could leave you with massive medical debt. Choose a plan with too much coverage and you could be left overpaying for additional coverage you don't necessarily need.We've created a quick guide to explain medicare qualifications while hopefully guiding you towards the right decisions as you choose a coverage plan.

Auscultation, Elderly Person
BSIP/UIG Via Getty Images
BSIP/UIG Via Getty Images

Medicare Eligibility

If you're 65-years-old or older there's good news, Medicare coverage is guaranteed. Every paycheck you received since you started working included a Medicare tax which was a form of pre-payment for your future.

If you're not 65-years-old you may still qualify for Medicare based on certain medical conditions and/or disabilities.

Choosing Your Medicare Eligibility

Medicare started with Medicare Part A which is free for all participants. This is a basic form of coverage that provides basic services such as doctor office visits and emergency care.

You can choose to stick with the original Medicare plan or move to a Medicare Advantage option.

The original medicare plan includes Part A and Part B while Medicare Advantage plans allow for private insurance company support.

The differences between Original Medicare and Medicare Advantage plans

With an original Medicare plan, you can visit any doctor or hospital that currently accepts Medicare coverage. These doctors and hospitals are located all throughout the United States.

Medicare's original plans don't include prescription drug coverage, if you require this insurance you can pay additional fees for Medicare Part D. Keep in mind, you'll already need to pay about 20% out of pocket for the cost of original Medicare plans.

Medicare Advantage is different in that everything is covered, also known as a "bundled package." In this case, you receive the benefits of Medicare Part A, Part B, and in many cases Part D.

A Medicare Advantage program can also include your dental, vision, and hearing expenses which ensures fewer out of pocket surprises for visits outside of the doctors office or emergency room and prompt care.

A Big Consideration For Your Prescription Drug Needs

Not all plans will cover every drug. If you currently receive a specific prescription you'll want to understand of Medicare Part D covers that prescription or if a Medicare Advantage plan will offer coverage for the drug.

Do You Need Supplemental Coverage?

Even with an Advantage plan, there are times when certain prescription drugs will not be covered. In those cases, you may need what is referred to as supplemental coverage or "Medigap."

The name of this program is denoted by the need to fill a "gap" in your Medicare coverage. Medigap is provided through private insurance companies.

Confused by Medigap? Look into Medicare Plan F coverage which provides Medigap support. This is a popular option that often covers the needs of Medicare recipients. A new option Plan G, could also be of great benefit, this plan, started in 2020, provides greater coverage, including nursing facility care.

Research Is Your Best Friend When Choosing Medicare Coverage

We've given you a baseline look at what Medicare coverage looks like. However, your own needs could vary greatly from those of other program participants. There are many online materials that can help you make informed decisions.

If paying more for additional protection is in your cards, you should probably examine Medicare Advantage programs and perhaps look at Medigap to ensure all your future needs are met. If you're on a more strict budget but still require additional coverage, a Medigap plan could help offset the cost of expensive prescriptions even with higher premiums to pay upfront. In any case, Medicare is a complex issue and researching all of your available options is important.References: Medicare