Six Tips for Choosing Medicare Coverage

Here are six tips to help you find a plan that works for your health needs and budget:

1. Know your options. You have two basic ways to get Medicare coverage—by choosing Original Medicare (with optional supplemental coverage and/or a separate prescription drug plan) or choosing a Medicare Advantage Plan (also known as Medicare Part C). Original Medicare includes Part A, which is hospital coverage, and Part B, which is medical coverage. With Original Medicare, you can add a standalone Medicare Part D Prescription Drug Plan or a Medicare Supplement Plan that provides additional coverage.

Medicare Advantage is a plan from a private insurer that provides the same coverage as Original Medicare Parts A and B and may include additional benefits or lower copayments. You may be required to get care within a network of doctors or other healthcare providers. Often, prescription drug coverage (Medicare Part D) is included as part of a Medicare Advantage plan.

2. Make a list of your healthcare needs. What healthcare services do you use regularly? How often do you see your primary care physician? How many specialists do you see a year? Are you anticipating any special needs, such as surgery? After you’ve made your list, check to see if these services are covered in the plans you’re considering and compare out-of-pocket costs such as copayments, coinsurance and deductibles.

3. Make a list of your medications. This list will help you determine which Medicare Prescription Drug Plan is best for you. Check each plan’s formulary to make sure your drugs are covered and compare out-of-pocket costs.

4. Make a list of your doctors and pharmacies. Check to see if they are participating in the networks of any plans you’re considering.

5. Consider choosing a plan with out-of-network benefits if you travel. If you spend a significantpart of the year in a second home, you need Medicare coverage that will travel with you. Check to make sure the plans you’re considering allow you to receive coverage outside of their network. If you plan to travel outside the United States, make sure that your plan provides coverage for emergency care outside the country.

6. Choose a plan that will fit your budget. If you don’t have many medical expenses, you may benefit from a plan with a low premium or no premium at all. These plans often have higher out-of-pocket expenses than plans with premiums but may be more cost-effective if you don’t use many services. Be sure to compare all the costs of the plans you’re considering, including premiums and out-of-pocket expenses, before making your decision.


Last updated: 01/01/2018

Blue Cross & Blue Shield of Rhode Island is an HMO plan with a Medicare contract. Enrollment in Blue Cross & Blue Shield of Rhode Island depends on contract renewal.