How to Select a Medicare Plan
That’s Right for You
Determine What Else You Need
Medicare Parts A and B don’t cover everything. Medicare A and B (known as
Original Medicare) only cover 80% of Medicare approved services, which leaves you responsible for the remaining 20%. Plus, Original Medicare has no prescription drug coverage. There are two ways to fill these gaps in coverage:
- Option 1: Add a Part D prescription drug plan and a Medicare Supplement plan to help lower your share of out-of-pocket expenses.
- Option 2: Get a Medicare Advantage Plan, also known as Part C. This is an all-in-one option that covers everything in Medicare A and B and includes Part D prescription coverage.
You can’t have an Advantage plan and a Supplement plan at the same time – you must pick one or the other.
Be Mindful of Enrollment Periods
You must enroll in Parts A and B before you can sign up for other coverage.
- Medicare Supplement (Medigap) plans: The best time to sign up is during the first six months after you turn 65. During this time, you have guaranteed issue rights, which means insurers cannot deny you coverage. If you want to enroll after this six-month window, you may have to take a written health screening questionnaire. Depending on your health, you could be charged more or be denied coverage.
- Medicare Part D and Medicare Advantage: You can enroll during your Initial Enrollment Period when you turn 65.
The coverage you choose needs to fit your budget.
- Medicare Advantage plans are often more affordable. Most insurers now offer $0 monthly premium plans. Usually, the lower the monthly premium, the more you pay out of pocket for deductibles, copays, and coinsurance. If you want a PPO plan with out-of-network coverage, the premiums will be higher. There is an annual out-of-pocket maximum that caps how much you will pay each year.
- Medicare Supplement monthly premiums can vary based on which plan you choose, which state you live in, the insurance carrier, and personal factors such as gender, marital status, and whether you are a smoker. There are 10 standardized Supplement Plans, each providing a different level of coverage to supplement Original Medicare. The average cost of a Supplement plan in 2023 is $155 per month.
- Medicare Part D plan premiums also vary depending on the plan you choose and where you are located. The average Part D premium in 2023 is $32.74 per month. High-income earners may pay more.
Remember, you will pay your Part B premium in addition to any other premiums. The standard Part B premium is $169.40 in 2023. You may pay more depending on your income.
Consider These Questions
The right coverage for you will depend on your financial situation, lifestyle, and health. To narrow down your options, ask yourself the following questions.
Needs that May Influence Your Plan Choice
Do you want the freedom to see any doctor or go to any hospital?
Private insurers that offer Medicare Advantage plans each have their own unique provider network. You must see the doctors and visit the hospitals in their networks. Some Advantage plans offer out-of-network coverage at higher rates. With Original Medicare, you can see any doctor or go to any hospital that accepts Medicare assignment anywhere in the county.
Do you travel extensively?
Medicare Advantage plans will cover emergency or urgent care anywhere in the country. You are not required to stay in network in these situations. If you have a PPO plan, you can see non-emergency medical providers outside the network at a higher out-of-pocket cost. With Original Medicare, you can see any Medicare-approved provider anywhere in the country.
Advantage plans and Original Medicare only cover specific circumstances for healthcare overseas. If you often travel internationally, you may want to consider a Supplement plan that offers more overseas coverage.
Do you have any chronic health conditions?
If you have a chronic health condition or significant ongoing health needs, you’ll need to analyze your choices carefully. Are there specific doctors and hospitals you want to use for your care? What is the coverage for specific procedures? If you take expensive medications, you’ll need to know how a specific insurer covers them, since each insurer has its own unique drug formulary.
How important are extra benefits?
Many Advantage plans now offer vision, dental, and hearing benefits. They may also include gym memberships and wellness programs. Some plans offer transportation to and from medical appointments and meal delivery when you first come home from the hospital. Many Advantage plans offer an over-the-counter benefit, which gives beneficiaries a monthly or quarterly allowance to buy everyday OTC medications and medical supplies.
Original Medicare does not offer these benefits. It does not cover routine vision or dental services but does offer some coverage in specific circumstances:
- Vision – You have coverage for medically-necessary screenings and eye exams for glaucoma, diabetes, and macular degeneration as well as cataract surgery and associated corrective lenses.
- Dental – You have coverage for dental services related to certain medical procedures, such as prior to cardiac valve replacement and organ transplants.
- Medicare Advantage 12-month trial period – If you enrolled in a Medicare Advantage plan when you were first eligible, you can use the trial period to switch to Original Medicare and sign up for a Supplement plan without penalty.
- Fall Annual Enrollment – This runs from October 15 to December 7 every year. During this time, you can change from one Advantage plan to another, change between a Medicare Advantage plan and Original Medicare, or enroll, drop, or switch Part D plans.
- Medicare Advantage Open Enrollment – This runs from January 1 to March 31 every year. You can switch to another Medicare Advantage plan or switch back to Original Medicare.
- 5-Star Enrollment – If you are enrolled in an Advantage or Part D plan, you can switch to another five-star plan in your area once during the year.
We’re Here to Help
The licensed Medicare agents at O’Neal Insurance Group can help simplify your Medicare choices. We will give you the personalized guidance you need to find the right plan for you.
Choosing the right Medicare plan is important.
We’re here to help.
Want some guidance? Work with a broker.
We provide free, unbiased advice, education and enrollment assistance – always abiding by our strict code of ethics.
You can call us anytime at 1-888-259-3339 (TTY:711), or use our form to schedule a remote or in-person appointment with a licensed agent (depending on where you live).
Prefer to shop on your own?
Our online enrollment tools makes it easy to compare your Medicare options.
When you click the button below, you’ll see two options: You can either enter your ZIP code to view the plans available in your area, or use our plan-finder tool to receive helpful guidance.