Medicare coverage comes in all shapes and sizes – five tips to finding the one for you

By Regence

November 02, 2022

When shopping for a Medicare health plan, it’s important to consider your personal health care needs, budget and lifestyle. Everyone’s health needs, finances and lifestyles are not the same. So, when it comes to choosing the right Medicare coverage, it’s a personal decision. Use these five tips to help you make the choice that meets your needs.

1. Decide if you need more coverage than what Original Medicare provides

One of the first things you’ll want to consider when deciding what coverage is best for you is whether “Original Medicare” (Parts A and B) is enough or if Medicare Advantage (Part C) coverage better meets your needs.

Part A covers inpatient hospital stays and skilled nursing facilities.
Part B covers outpatient care like doctor visits and lab tests.
Part C (Medicare Advantage Plans) replaces Original Medicare and usually includes coverage for prescription drugs and routine dental, vision and hearing services.

2. Understand your out-of-pocket costs

Medicare Advantage plans help you predict out-of-pocket costs better than you can with Original Medicare. Since these plans have a yearly limit on what you pay out of pocket, once you reach your out-of-pocket maximum, your plan usually pays 100% of covered services for the rest of the year. There are three other factors you’ll want to consider when comparing costs:

Premium: The amount you pay each month is based on the plan you choose. Some Medicare Advantage plans have a $0 premium.
Deductible: What you pay for covered medical services, excluding preventive services, before your insurance starts to pay. Typically, the lower your deductible is, the higher your monthly premium is – and vice versa.
Cost-sharing: What you pay for covered services after you’ve met your deductible and until you meet your out-of-pocket maximum.

3. Select a plan that includes your providers and prescriptions on a plan’s formulary

Make sure your entire care team is in-network under the plan you choose. This includes your primary care provider, preferred hospitals and any specialists you see, plus any pharmacies you use to fill your prescriptions.

4. Choose coverage with benefits and programs that keep you healthy

Beyond traditional health care coverage, most Medicare Advantage plans offer extra benefits that may include nutrition support, over-the-counter supplies, wellness benefits (like a gym membership) and more. If travel is part of your plans, you’ll want to make sure you can get care when you’re away from home. All Regence Medicare Advantage plans cover urgent and emergency care (including ambulance services) when you travel domestically or abroad.

5. Find a licensed agent in your area

During Medicare’s Annual Enrollment Period, you may see commercials with celebrities enticing you with promises of the perfect plan. But what they don’t tell you is that the benefits they’re talking about aren’t always available in your area.

When looking for a health plan that’s right for you, it helps to work with a local health insurance agent who understands benefit options that are exclusively available in your area. We can help you find local licensed agents at regence.com/medicare.