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Evaluate your options

See What Plan Type Your Peers Might Select

There is a lot to consider when choosing a Medicare plan. The different types of plans provide coverage that fit different types of situations. When making your decision, it helps to take into account the following factors: your budget; your health, including any chronic conditions; your prescriptions drug needs and your lifestyle.

See examples below of four scenarios with common enrollment challenges and the Medicare choices that could be made.*

 
bill drinking coffee

Bill

Plan Type Selected: Medicare Advantage Plan 

Bill is in good health and regularly takes one prescription drug. Since he normally only visits the doctor once a year for his annual exam, he wanted a plan with a low monthly premium. Lower premium plans have higher copays/coinsurance, which could put Bill at financial risk if his health worsens and he needs more medical services than normal.

Bill's Medicare solution:
Bill discovered that a Medicare Advantage plan could provide the medical and prescription coverage he needs in one plan with a low premium and reasonable out of pocket costs if he stays relatively healthy. If his health worsens, he knows his plan has a maximum out-of-pocket limit of $6,000 that would contain his financial risk.

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robert and susan sitting together

Robert & Susan

Plan Type Selected:
Medicare Cost Plan with Part D (Robert)
Medical-only Medicare Cost Plan (Susan)

Robert and Susan each wanted a Medicare plan that gave them options since they have different needs and preferences. Robert has a chronic condition that requires regular visits to a specialist and frequent tests. He also takes several prescription medications. Susan has a chronic back problem. She visits her primary care physician once a year but sees a chiropractor for her back 3 - 6 times a year. She does not take any prescription medications but wanted to enroll in drug coverage when first eligible so she would never have to pay a Part D late enrollment penalty.

Robert’s Medicare Solution:
Robert selected a Cost plan that has low copays for his doctor visits and a reasonable monthly premium. The plan includes a free fitness membership, which Robert likes because he wants to drop about 10 pounds. He decided to bundle his medical coverage with the Cost plan’s optional prescription coverage since his drugs were covered by the formulary and the copays were low.

Susan’s Medicare Solution:
Susan chose a medical-only Cost plan with modest copays for doctor visits and an affordable monthly premium. Most importantly to her, the chiropractor she had been seeing for more than a decade was in the provider network. She did not purchase the optional prescription drug coverage offered by her Cost plan. She chose instead to enroll in a stand-alone Part D plan with a very low monthly premium and basic coverage since she does not normally take prescription medications.

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linda smiling

Linda

Plan Type Selected: Medicare Supplement Plan

Linda likes to be prepared. She is in relatively good health and takes a commonly prescribed cholesterol medication. She was hospitalized a few years ago after a car accident and was shocked at how much she had to pay out of pocket with her health plan at the time. Her top priority for her Medicare coverage was to find a plan with no copays and little risk for unexpected costs. Her top priority for her retirement is to travel and visit friends and family across the country.

Linda's Medicare Solution:
Linda found a Medicare Supplement (Medigap) plan that offered her the predictable coverage she wanted. There are no copays for most medical services and the maximum out of pocket limit is only $1,000.  The monthly premium is around $200 so she knows the most she would pay in a year is about $3,400 regardless of any changes to her health. Plus, her coverage travels with her - she can see any doctor in the country who accepts Medicare. Because Medicare Supplement plans do not include prescription coverage, Linda also purchased a stand-alone Part D drug plan with predictable copays.

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Man playing with his grandchildren.

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*Scenarios describe fictional people and are for illustrative purposes only.

Medica is a Cost and HMO-POS plan with a Medicare contract. Enrollment in Medica depends on contract renewal.

Y0088_4951 CMS Pending
Last Updated: October 2017