Choosing the Right Medicare Plan for You

medicare maze

From traditional Medicare to Medicare Advantage plans to Medigap policies, you have plenty of options

As you approach 65, you face an important milestone: You will become eligible for Medicare.

Keep in mind, it’s important to understand the ins and outs of Medicare before you sign up. Making the wrong choices can lead to the wrong coverage or it can be expensive.

Even if you’ve been on Medicare for years, you may want to review your options annually to make sure you’re getting the right plan. The annual open enrollment period for Medicare Advantage, during runs from October 15 through December 7, which is the time you can change plans. Medicare Part D drug plan or a Medicare Advantage plan can change significantly from year to year, dropping and adding drugs and doctors or changing copays and deductibles.

The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period, because you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you’re 65 and enrolled in Medicare Part B (Medical Insurance). After this enrollment period, you may not be able to buy a Medigap policy. If you’re able to buy one, it may cost more.

Things to know

Medicare plans are actually broken into multiple parts:

  • Part A covers hospital care, skilled nursing, hospice and some home health care. If you or your spouse has at least 10 years of Social Security work history, this part is free. If you don’t have that work history, it can be up to $411 per month. Your premium amount is determined by how many Social Security work credits you have.
  • Part B covers doctor visits, preventive care, outpatient care and hospitals and some home health care. In 2016, this part cost $121.80 a month for Medicare beneficiaries whose incomes are $85,000 a year or less ($170,000 for a couple). It increases from there based on individual or combined income.
  • Part C is also known as a Medicare Advantage plan. It substitutes for parts A and B and, in most cases, Part D, the drug plan. Premiums vary based on location and coverage. According to the Centers for Medicare & Medicaid Services, the average premium in 2016 will be $32.60.
  • Part D covers prescription drugs. Premiums also vary based on coverage but can run from about $15 to $50 per month.

The first big decision Medicare beneficiaries need to make is whether to go with traditional Medicare (parts A, B and D) or a Medicare Advantage plan (Part C). Medicare Advantage plans have lower premiums, but they usually require members to get their care only from network doctors and hospitals. Both options have deductibles, copays and co-insurance, where you pay a percentage of the bill.

Those who choose traditional Medicare usually add a Medigap policy, which is a supplemental policy that covers what Medicare doesn’t. There are 10 types of Medigap policies, offered by private insurers or via groups such as AARP, and costs vary considerably, based on gender, age, health, whether you smoke, location and company.

Whether you are new to Medicare or are deciding if you should change plans during Medicare’s Annual Enrollment Period for Medicare Advantage plans, more commonly called Medicare open enrollment, you should gather information from a variety of sources.