When, Why, and How to Choose a Plan That’s Right For You
(Especially if you’re already enrolled)
Whether you’re looking into Medicare for the first time, or taking advantage of Annual Enrollment to update your strategy, we’ve broken down the critical choices you must make into a simple decision-making tool (including the easy-to-understand questions you MUST ask yourself before choosing a plan).
Important! Medicare rules are changing rapidly. This guide is designed to give you updated information for 2024.
Getting the answers wrong can cost you big-time!
Not only is health care likely to be your largest expense in your retirement (potentially $315,000 or more), but nearly every American over age 65 will eventually enroll in Medicare.
Making the wrong choices could:
- cost you thousands in permanent penalties
- leave you facing high medical bills without coverage
- or force you into a too-expensive plan.
Let’s go through a shockingly simple set of questions to help you choose a Medicare plan.
By virtue of its simplicity, this decision-making tool leaves out most of the nitty gritty.
Have any questions along the way? Just click the “Start Here” button on the top corner of the page to book a 100% free, 1-on-1 consultation to get help making these critical (and time-sensitive) decisions.
1 – Do You Need To Enroll In Medicare?
Are you at least 65?
Unless you qualify for disability, you typically don’t qualify for Medicare until age 65. There are some exceptions to that rule, so if you have questions about your eligibility, book a free chat to discuss. We’ll help you determine exactly when you need to enroll in Medicare.
Are you covered by employer-sponsored or retiree health insurance?
If so, and your employer has at least 20 employees, you may not need to enroll in Medicare yet.
Do you qualify for VA benefits or TriCare?
If so, you may still need to enroll in Medicare Part B because VA and Medicare benefits do not overlap.
Warning!
If you are eligible for Medicare coverage and are not covered by qualifying insurance, you should consider enrolling in Medicare ASAP to avoid late enrollment penalties and higher premium costs.
2 – Which Medicare plan is right for you?
Choosing a Medicare plan means balancing priorities and knowing what’s most important to you. Remember—there are no right or wrong answers to these questions.
CHOOSING BETWEEN ORIGINAL MEDICARE (PARTS A + B) AND A MEDICARE ADVANTAGE PLAN (PART C)
Which sounds like you?
I already have doctors and specialists, and don’t want to switch.
I travel away from home and want coverage that spans the entire United States.
I value the freedom to visit almost any doctor, hospital, and medical provider that accepts Medicare.
If This Is You, You Should Consider Original Medicare Part A (Hospital Insurance) + Part B (Medical Insurance)
I don’t mind going through a primary care physician to see specialists.
I stay close to home and can find a doctor within my network.
I value simplicity and don’t want to manage multiple insurance plans.
If This Is You, You Should Consider a Medicare Advantage Plan (Part C)
Part A covers hospitals, rehab, and hospice care, whereas Part B covers doctor visits, lab tests, screenings, and other outpatient services.
While Part A is free for most people, you’ll pay monthly premiums for Part B plus deductibles, copays, and coinsurance.
Pros: You have the freedom to visit any provider or hospital in the U.S. that participates in Medicare and you don’t need to work with a primary care physician to see specialists. This flexibility is ideal if you travel outside of your home network or have existing relationships with doctors you want to keep.
Cons: Services have deductibles and copays, which may require you to purchase a Medigap or Medicare Supplement Plan to control your out-of-pocket spending. You will also need to purchase prescription drug coverage (Medicare Part D) separately.
Offered through private insurers, Part C is often structured like an HMO or PPO and provides comprehensive health coverage combining Parts A and B.
Pros: Many Part C plans cover extra services like vision, hearing, and dental and may include prescription drug coverage. Plans have an annual limit on your total out-of-pocket costs.
Cons: In addition to paying a Part B premium, you’ll typically pay an extra monthly premium for the Medicare Advantage plan. Networks change, doctors can leave, and benefits can change over time.
Now, let’s talk about any prescription drug coverage you may need…
CHOOSING ORIGINAL MEDICARE (PART A + PART B)?
You’ll need to sign up as soon as you become eligible for Medicare, even if you don’t use prescription drugs, to avoid paying late enrollment penalties.
Pros: Copays and other plan details vary by state and insurer, but they will cover most of the cost of your prescriptions.
Cons: After exceeding coverage limits, you’ll pay the full cost of your medications until a Medicare threshold is reached.
Let’s see if you need supplemental insurance to lower your out-of-pocket costs.
Do you have retiree coverage through the military or a private company?
Most Medicare participants had some type of supplemental coverage.
If not, you may want to consider a Medicare Supplement Plan or Medigap.
What is it?
Private insurance that fills the coverage gaps in Parts A and B of Medicare and helps with deductibles, copays, coinsurance, etc.
Pros: It limits your out-of-pocket costs for Original Medicare.
Cons: There are many different types of Medigap plans, all with different details.
CHOOSING A MEDICARE ADVANTAGE PLAN (PART C)?
3 – How Do You Enroll?
There are several ways to enroll in Medicare, whether you plan to retire or keep working:
If you begin receiving Social Security retirement benefits between age 62 and up to 4 months before turning 65, you will be automatically enrolled in Medicare Part A and Part B when you turn 65.
If you apply for Social Security 3 months before you turn 65 or later, you can sign up for Medicare when you apply for Social Security.
The Initial Enrollment Period to sign up for Medicare begins 3 months before you turn 65 and ends 3 months after the month you turn 65 — a total of 7 months.
You may have to pay a penalty if you miss your Initial Enrollment Period.
WHAT YOU’LL NEED WHEN ENROLLING IN MEDICARE
- Basic information about yourself
- Social Security number
- Where you were born (city, state, country)
- Health insurance information
- Start and end dates for any current group health plans
- Start and end dates for any group health plans after age 65
For Part B only
- Valid email address
- Your existing Medicare number
If you are not ready to receive Social Security benefits at 65 because you are still working, you can apply online for Medicare only.
Or you may be able to wait until you retire to sign up during a special enrollment period.
As a taxpayer, you’ve earned the right to your Medicare benefits.
If this guide hasn’t given you 100% confidence in your next steps, you don’t need to go it alone.
Right now, you might be asking yourself questions like:
How do I enroll?
When is my next enrollment period?
Which doctors and hospitals will take my plan?
How much are my premiums, deductibles, and services going to cost?
How do I balance coverage with price?
Do I have to medically qualify?
