Top Questions to Ask Before Choosing Your Medicare Plan

Understanding Your Medicare Options

Before diving into specific questions, it's helpful to understand the main types of Medicare coverage available to you.
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Original Medicare (Parts A and B) provides hospital insurance and medical insurance through the federal program. Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Part B covers doctor visits, outpatient care, medical supplies, and preventive services.
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Medicare Advantage (Part C) combines Parts A and B into a single plan offered by private insurance companies approved by Medicare. These plans often include prescription drug coverage and may offer additional benefits like dental, vision, or hearing aids.
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Medicare Supplement Insurance (Medigap) works alongside Original Medicare to help cover costs like copayments, coinsurance, and deductibles that Original Medicare doesn't pay.
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Medicare Part D provides prescription drug coverage through private insurance companies, either as a standalone plan with Original Medicare or included in a Medicare Advantage plan.
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Understanding these basic options sets the foundation for making an informed choice about which combination works best for your situation.
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Question #1: What Are Your Current and Expected Prescription Needs?

Your medication needs should play a central role in your Medicare plan selection. Start by creating a comprehensive list of all prescription drugs you currently take, including the dosage and frequency. Don't forget about over-the-counter medications your doctor has recommended or any supplements you take regularly.
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Consider not just your current needs, but what might change in the coming year. Are you managing any chronic conditions that might require new medications? Has your doctor mentioned potential treatment changes? These factors can significantly impact which plan offers the best value.
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Each Medicare plan maintains a formulary—a list of covered drugs—and your medications might be covered differently across plans. Some plans may require prior authorization for certain drugs, while others might not cover your specific medication at all. The tier level of your medications within a plan's formulary directly affects your out-of-pocket costs.
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Remember that significant changes are coming to Medicare Part D in 2025 and 2026, including a $2,000 annual cap on out-of-pocket prescription drug costs. This change will provide valuable financial protection, especially for those with high medication costs.

Question #2: Are Your Preferred Doctors and Specialists In-Network?

Your relationship with your healthcare providers is invaluable, and maintaining continuity of care should be a top priority when selecting a Medicare plan. Start by making a list of all your current healthcare providers, including your primary care physician, specialists, and any other practitioners you see regularly.
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Medicare Advantage plans typically use provider networks to manage costs and coordinate care. If staying with your current doctors is important to you, verify that they accept the specific Medicare Advantage plan you're considering. Keep in mind that provider networks can change from year to year, so a doctor who accepts your plan this year might not next year.
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With Original Medicare, you generally have more flexibility to see any doctor or specialist who accepts Medicare assignment. However, you'll want to confirm that your preferred providers accept Medicare and understand any potential out-of-pocket costs.
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Don't forget to consider the hospitals you prefer or might need to use. If you have a strong preference for a particular hospital system or have an ongoing relationship with a specific facility, ensure it's covered under your chosen plan.
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Question #3: Do You Plan to Travel Outside the United States?

Your travel plans, both domestic and international, can significantly influence which Medicare plan is right for you. If you spend part of the year in different states or travel frequently within the U.S., you'll want to understand how your coverage works outside your plan's service area.
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Medicare Advantage plans typically provide coverage only within their service areas, though they must cover emergency and urgent care anywhere in the United States. Some plans offer additional coverage for emergencies while traveling abroad, but this varies significantly between plans.
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Original Medicare provides coverage throughout the United States, which can be beneficial if you travel frequently or spend extended periods in different states. However, Original Medicare generally doesn't cover healthcare services outside the U.S., except in limited emergency situations.
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If international travel is part of your lifestyle, consider whether you need additional coverage for medical emergencies abroad. Some Medicare Supplement plans offer foreign travel emergency coverage, which could provide valuable peace of mind for frequent international travelers.
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Question #4: What Extra Benefits Matter Most to You?

Many Medicare Advantage plans offer additional benefits beyond what Original Medicare covers. These extra benefits can add significant value to your plan, but it's important to focus on what you'll actually use rather than being swayed by benefits that sound appealing but don't match your needs.
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Common additional benefits include dental coverage, vision care, hearing aids, wellness programs, gym memberships, and transportation to medical appointments. Some plans also offer coverage for services like acupuncture, chiropractic care, or nutrition counseling.
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When evaluating these benefits, consider both your current needs and what might become important as you age. For example, if you currently have good dental health, you might not prioritize comprehensive dental coverage. However, if you have a family history of dental issues or are already experiencing problems, robust dental benefits could save you significant money.
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Be sure to understand the details of any extra benefits. Some plans offer generous-sounding benefits that come with significant limitations or restrictions that make them less valuable in practice.
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Question #5: How Do the Total Medicare Plan Costs Compare?

Understanding the true cost of a Medicare plan goes far beyond the monthly premium. A comprehensive cost comparison should include monthly premiums, annual deductibles, copayments for doctor visits and specialist care, coinsurance for hospital stays and outpatient services, and out-of-pocket maximums.
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For prescription drugs, consider both the monthly premium for Part D coverage and the actual cost of your medications under each plan's formulary. The plan with the lowest premium might not be the most cost-effective if your medications are expensive under that plan's coverage structure.
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Medicare Advantage plans have an annual out-of-pocket maximum that limits your total spending for covered services, providing important financial protection. Original Medicare doesn't have this built-in limit, which is one reason many people choose to add Medicare Supplement insurance.
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Don't forget to factor in the cost of Medicare Part B, which most people pay regardless of whether they choose Original Medicare or Medicare Advantage. Higher-income beneficiaries may pay more for Part B through Income-Related Monthly Adjustment Amounts (IRMAA).
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Finding The Medicare Plan for Your Health Needs

Choosing a Medicare plan is a personal decision that depends on your unique circumstances, health needs, and preferences. The questions outlined above provide a framework for evaluating your options, but you don't have to navigate this process alone.
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Our online Medicare enrollment tool can help you compare plans available in your area based on your specific needs and preferences. You can enter your medications, preferred doctors, and other priorities to see which plans offer the best combination of coverage and cost for your situation.
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Remember that you have opportunities each year during the Annual Open Enrollment Period (October 15 - December 7) to review and change your Medicare coverage. This yearly opportunity ensures you can adjust your coverage as your needs evolve.
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Ready to explore your Medicare options? Use our online enrollment tool to see plans available in your area, or contact one of our Medicare experts for personalized guidance. With the right plan in place, you can have confidence that your healthcare needs are covered, giving you the peace of mind you deserve.