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Questions to Consider When Applying for Medicare Coverage

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Before you apply for Medicare, it’s critical for you to be aware of how Medicare coverage fits in with your health and drug needs, now and in the future. There are several types of Medicare plan options, and many factors you may need to consider when choosing or changing your Medicare coverage.

What benefits will my Medicare plan option deliver?

Original Medicare, Part A and Part B, doesn’t cover vision services, routine dental care, or out-of-the-country medical expenses.

Either of the following types of Medicare plan options might cover costs not covered by Original Medicare (coverage varies by the plan). Your costs would also vary depending on the plan you chose.

  • A Medicare Supplement insurance plan is insurance you buy from a private insurer. You must also have, and keep, Original Medicare (Part A and Part B).
  • A Medicare Prescription Drug Plan is stand-alone coverage you can add if you’re enrolled in Original Medicare. You must be enrolled in Medicare Part A and/or Part B and live in the plan’s service area to enroll in a Medicare Prescription Drug Plan.

There’s also another Medicare plan option. A Medicare Advantage plan provides the same coverage as Original Medicare (Part A and Part B) except hospice care, and often includes additional coverage such as prescription drugs, vision services, or dental services. The Medicare Advantage plan would administer your Medicare benefits, but you would have to continue paying your Medicare Part B premium.

When choosing what type of coverage to get, you might want to consider:

  • Do you need vision services, such as routine eye exams and glasses?
  • Do you want coverage for routine dental services?
  • Do you travel outside the U.S. frequently?
  • Are you covered by Medicaid?
  • If you need prescription drug coverage, will your Medicare Advantage plan include it?

What will my Medicare plan option costs be?

How much will health-care costs affect your budget? Before you decide on a Medicare plan, you will need to know how much you’ll pay for it. Some of the costs can include:

  • Monthly premium
  • Yearly deductible
  • Copayment and coinsurance
  • Prescription drug coverage gap (also called the donut hole)
  • Possible late-enrollment penalties

Will this plan option be convenient for me?

Will the doctors and hospitals you currently prefer be included in your specific Medicare Advantage plan network or accept Medicare assignment at all? There are some health-care providers who don’t accept new patients who are enrolled in a Medicare Advantage plan. Ask if referrals are necessary, and whether you’re obligated to choose medical care within your network before you choose a Medicare Advantage plan. You may want to ask yourself the following questions regarding your Medicare plan:

  • Are health-care providers close by?
  • Does your plan’s doctor have a work schedule that meets your needs?
  • Are your plan’s pharmacy hours acceptable?
  • Will the plan cover medical costs if you travel from state to state? In foreign countries?

Do I need prescription drug coverage?

When it comes to prescription drug coverage (Medicare Part D), you have a couple options. You can enroll in a stand-alone Medicare Part D Prescription Drug Plan if you have Original Medicare. Or you can enroll in a Medicare Advantage plan that includes drug benefits, also known as a Medicare Advantage Prescription Drug plan. When looking at your Medicare plan options, consider the following prescription drug questions:

  • Do you already have creditable coverage for prescription drugs?
  • Do you take prescription drugs now? Do you expect to need them in the future? Even if you don’t need medications now, it might be a good idea to enroll in a Medicare Prescription Drug Plan as soon as you’re eligible for Medicare. This can avoid a late-enrollment penalty later. See What is Medicare Part D? for details.
  • Do you have a preferred pharmacy and, if so, is it included in provider network of the Medicare plan you’re considering?
  • Will the Medicare plan support your need for specific medications?
  • Will your doctor have to provide prior authorization for any of your prescription drugs?

How do different plans compare in quality?

What is the Medicare plan’s star rating? The Centers for Medicare & Medicaid Services (CMS) uses several sources of information, including but not limited to member satisfaction surveys and information provided by health care providers to determine overall performance ratings for Medicare plans, including Medicare Prescription Drug Plans and Medicare Advantage plans.

A Medicare plan can receive a rating between one and five stars. A five-star rating is considered excellent and represents a high-quality plan. Be sure to review the ratings for each Medicare plan that interests you before you apply for Medicare.

You can find these ratings when you access eHealth’s plan comparison tool; just enter your zip code in the box on this page. Or, you can visit the website. You can also call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. Medicare representatives are available by phone 24 hours a day, 7 days a week.

Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

Would you like to take a look at some of the Medicare plans available in your area? Just enter your zip code in the box on this page to display a list and start comparing plans.

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