Medicare Buying Checklist: 20 Things to Know Before You Enroll
Approximately 60 million Americans are
enrolled in Medicare. Whether you’re signing up for the first time or taking
advantage of the fall open enrollment period to change your plan, here are 20
things to check before you enroll.
- Original Medicare vs. Medicare Advantage – Medicare enrollees can choose either
Original Medicare or Medicare Advantage. Original Medicare refers to Medicare
Parts A and B. Medicare Advantage, also called Medicare Part C, is offered by
private companies and provides Medicare Part A and B coverage and may offer
- Prescription Drug Coverage – Many Medicare Advantage plans include prescription drug
coverage. However, if you are enrolled in Original Medicare, or if you’re
enrolled in a Medicare Advantage plan without drug coverage, you will need to
enroll in a Medicare Part D plan to get coverage.
- Medicare Part B Premium – The amount you pay for Medicare Part B is based on your
income. In 2020, the standard monthly premium is $144.60, but you might pay
more depending on your income.
- Medicare Advantage Premium – If you enroll in a Medicare Advantage plan, you pay the
Medicare Advantage premium on top of the Medicare Part A premium. However, many
Medicare Advantage plans have a $0 premium, which means you don’t pay an
additional premium. In 2020, the average monthly Medicare Advantage premium is
- Medicare Part D Premium – Medicare Part D premiums have been going down. In 2020,
the average monthly premium is $30.
- Out-of-Pocket Costs – Copays and deductibles vary in Medicare Advantage plans.
Make sure you know how much you’ll be paying out of pocket for care.
- Out-of-Pocket Maximum – Original Medicare does not have an out-of-pocket maximum,
but Medicare Advantage plans do. This means that if you enroll in a Medicare
Advantage plan, there’s a limit to how much you can spend in a year.
- Hearing – Original Medicare doesn’t cover hearing aids or exams, but
some Medicare Advantage plans do.
- Dental – Original Medicare doesn’t cover most dental services, but
some Medicare Advantage plans do.
- Vision – Original Medicare doesn’t cover glasses or routine eye
exams, but some Medicare Advantage plans do.
- Non-Medical Benefits – Some Medicare Advantage plans are adding non-medical
benefits, such as meal delivery and transportation. Check for these benefits.
- Telehealth – Some Medicare Advantage plans may be expanding telehealth benefits.
Check for telehealth coverage if this would be convenient for you.
- Other Benefits – Medicare Advantage plans may offer other benefits, such as
acupuncture. Check for any additional benefits you’re interested in.
- Special Needs Plans – Special Needs Plans (SNPs) are Medicare Advantage plans
designed for people with special needs. There are plans for people with
specific chronic conditions, people who are dual eligible for Medicare and
Medicaid and people who live in an institution. See if you qualify for any SNPs
in your area.
- Drug Formulary – Check your drug plan’s formulary to see whether your
prescriptions are covered and how much you’ll pay.
- Networks and Plan Type – Medicare Advantage plans typically use a network of
providers and hospitals. If you go out of network, your treatments may not be
covered. How your plan works will depend on the type of plan it is. The most
common types include HMO, PPO and PFFS plans.
- Providers – Check your plan’s network to see if your favorite
providers, including any specialists you see, are in the network. Otherwise,
your visits may not be fully covered.
- Hospitals – Check your plan’s network to see which hospitals are in the
- Pharmacies – Check your drug plan to see which pharmacies accept
coverage and offer the best prices for the prescriptions you take.
- LIS Eligibility – Low Income Subsidies are available to help qualifying
enrollees afford prescription drug coverage. See if you qualify. If you do,
contact your drug plan and make sure you’re paying the right amount.
Want to speak with a licensed agent
about the best Medicare Insurance plan for you? Request a quote from Insurance Line One.