Some people need to get additional coverage, like Medicare drug coverage or Medicare Supplement Insurance (Medigap).
NOTE - If you don't get Medicare drug coverage or Medigap when you're first eligible, you may have to pay more to get this coverage later. This could mean you’ll have a lifetime premium penalty for your Medicare drug coverage.
Medicare Advantage
Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.
Plans may have lower out-of-pocket costs than Original Medicare.
In many cases, you’ll need to use doctors and other providers who are in the plan’s network and service area for the lowest costs.
Most plans offer extra benefits that Original Medicare doesn’t cover. (Coverage varies by plan) Vision Hearing Dental Transportation services for non-emergency care to Plan-approved locations Fitness Benefits Worldwide Emergency Assistance Telehealth Over the Counter Drugs
Consider Coverage when choosing coverage
Original Medicare - Medicare covers medical services and supplies in hospitals, doctors’ offices, and other health care settings. Services are either covered under Part A or Part B.
Medicare Advantage - Plans must cover all of the services that Original Medicare covers. Some plans offer benefits that Original Medicare doesn’t cover like vision, hearing, or dental.
Consider Costs when choosing coverage
How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.
Original Medicare - There’s no limit on how much you pay out-of-pocket per year unless you have supplemental coverage.
Medicare Advantage - Plans have a yearly limit on your out-of-pocket costs. If you join a Medicare Advantage Plan, once you reach a certain limit, you’ll pay nothing for covered services for the rest of the year. This option may be more cost effective for you.
Consider Your Other Coverage when choosing coverage
If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. If you have employment-related coverage or get your health care from an Indian Health or Tribal Health Program, talk to your benefits administrator or insurer before making any changes.
Original Medicare -You can add a Medigap policy to help pay your out-of-pocket costs in Original Medicare, like your deductible and coinsurance.
Medicare Advantage - It may be more cost effective for you to join a Medicare Advantage Plan because your cost sharing is lower (or included). And, many Medicare Advantage plans offer vision, hearing, and dental.
NOTE - You can’t use (and can’t be sold) a Medigap policy if you’re in a Medicare Advantage Plan.
Most Medicare Advantage Plans include drug coverage. If yours doesn't, you may be able to join a separate Part D plan.
Doctor and Hospital Choice - Key Questions when choosing coverage
Do your doctors accept the coverage?
Are the doctors you want to see accepting new patients?
Do you have to choose your hospital and health care providers from a network?
Do you need to get referrals?
Doctor and Hospital Choice in Medicare Advantage
You may need to use health care providers who participate in the plan’s network. If so, find out how close the network’s doctor or pharmacies are to your home. Some plans offer out-of-network coverage.
Doctor and Hospital Choice in Original Medicare
You can go to any doctor that accepts Medicare.
Quality of Care - Key Questions when choosing coverage
Are you satisfied with your medical care? The quality of care and services offered by plans and other health care providers can vary.
Overall STAR Rating for Plan when choosing coverage
Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to plans. A plan can get a rating between 1 and 5 stars. A 5-star rating is considered excellent. These ratings help you compare plans based on quality and performance.
Overall STAR Rating - Overall rating is based on the following categories. Brokers will quote the Overall STAR Rating.
Plan Comparison to Original Medicare
Yearly flu vaccine, Ease of getting needed care and seeing specialists, getting appointments and care quickly, Health plan provides information or help when members need it, Member's rating of health care quality, Member's rating of health plan, Coordination of members' health care services
Staying Healthy: Screenings, Tests, and Vaccines
Breast Cancer Screenings, Colorectal cancer screening, Yearly Flu Vaccine, improving physical and mental health, Monitoring Physical Activity, and Checking to see if you are at a healthy weight
Managing Chronic (Long Term) Conditions
Health Assessments, Yearly review of medications and supplements, Pain Management Screening, Osteoporosis management, Reduce Risk of Falls, Rheumatoid arthritis management, members with diabetes, makes sure members with heart disease get the most effective drugs to treat high cholesterol
Member Experience with plan
Ease of getting needed care and seeing specialists, getting appointments and care quickly, Health plan provides information or help when members need it, Member's rating of health care quality, Member's rating of health plan, Coordination of members' health care services
Member Complaints & Changes in the Health Plan's Performance
Complaints about the health plan (more stars are better because it means fewer complaints), Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan), Improvement (if any) in the health plan's performance
Health Plan Customer Service
Health plan makes timely decisions about appeals, Fairness of the health plan's appeal decisions, based on an independent reviewer, Availability of TTY services and foreign language interpretation when prospective members call the health plan Medicare updates these ratings each fall for the following year. These ratings can change each year. NOTE - If a Medicare Advantage Plan, Medicare drug plan, or Medicare Cost Plan with a 5-star rating is available in your area, you can use the 5-star Special Enrollment Period to switch from your current Medicare plan to a Medicare plan with a “5-star” quality rating. You can use this Special Enrollment Period only once between December 8 and November 30.
Travel
Original Medicare generally doesn’t cover care outside the U.S. You may be able to buy supplemental insurance that offers travel coverage.
Medicare Advantage Plans usually don’t cover care you get outside of the US