To join a Medicare health plan or drug plan, you generally must:
- Have Medicare Part A (Hospital Insurance) and Part B (Medical Insurance)
- Live in the service area of the plan you want to join
- Be a U.S. citizen or lawfully present in the U.S.
- Have your Medicare Number and your Part A and/or Part B coverage start dates
When:
You can only join, switch, or drop a Medicare Advantage Plan (Part C), other Medicare health plan, or Medicare drug plan (Part D) at certain times, called enrollment periods. To learn more about enrollment period go to:
https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan
What You Should Consider Before You Enroll
Costs
Questions To Consider
- How much are your premiums, deductibles, and other costs?
- How much do you pay for services like hospital stays or doctor visits?
- Is there a yearly limit on what you could pay out-of-pocket for medical services?
- Make sure to ask questions about any coverage rules that may affect your costs
Costs in Original Medicare
There’s no limit on how much you pay out-of-pocket per year unless you have supplemental coverage such as Medigap.
Costs in Medicare Advantage
Plans have a yearly limit on your out-of-pocket costs. If you join a Medicare Advantage Plan, once you reach a certain limit, you’ll pay nothing for covered services for the rest of the year. This option may be more cost effective for you.
Coverage
Questions
- How well does the plan cover the services you need?
Costs in Original Medicare
Medicare covers medical services and supplies in hospitals, doctors’ offices, and other health care facilities. Services are either covered under Part A or Part B.
Costs in Medicare Advantage
Plans must cover all of the services that Original Medicare covers. Some plans offer benefits that Original Medicare doesn’t cover like vision, hearing, or dental.
Any Other Coverage
If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. If you have employment-related coverage, or get your health care from an Indian Health or Tribal Health Program, talk to your benefits administrator or insurer before making any changes.
Supplemental coverage in Original Medicare
You can add a Medigap policy to help pay your out-of-pocket costs in Original Medicare, like your deductible and coinsurance.
Supplemental coverage in Medicare Advantage
It may be more cost effective for you to join a Medicare Advantage Plan because your cost sharing is lower (or included). And, many Medicare Advantage plans offer vision, hearing, and dental. You can’t use (and can’t be sold) a Medigap policy if you’re in a Medicare Advantage Plan.
Prescription drugs
Questions
- Do you need to join a Medicare Prescription Drug Plan?
- Do you already have a creditable or equally comparable prescription drug coverage as a Medicare prescription drug coverage?
- Will you pay a penalty if you join a drug plan later?
- What’s the plan’s overall star rating?
- What will your prescription drugs cost under each plan?
- Are your drugs covered under the plan’s formulary?
- Are there any coverage rules that apply to your prescriptions?
Prescription drug coverage in Original Medicare
You’ll need to join a Medicare Drug Plan (Part D) to get drug coverage.
Prescription drug coverage in Medicare Advantage
Most Medicare Advantage Plans include drug coverage.
Doctor and Hospital Choice
Questions
- Do your doctors accept the coverage?
- Are the doctors you want to see accepting new patients?
- Do you have to choose your hospital and health care providers from a network?
- Do you need to get referrals?
Doctor and hospital choice in Original Medicare
You can go to any doctor that accepts Medicare.
Doctor and hospital choice in Medicare Advantage
You may need to use health care providers who participate in the plan’s network. If so, find out how close the network’s doctor or pharmacies are to your home. Some plans offer out-of-network coverage.
Quality Of Care
Questions
- Are you satisfied with your medical care?
- How have health and drug plan’s care and services been rated?
The quality of care and services offered by plans and other health care providers can vary.
Travel
Travel coverage in Original Medicare
Original Medicare generally doesn’t cover care outside the U.S. You may be able to buy supplemental insurance that offers emergency care when you travel outside of the U.S.
Travel coverage in Medicare Advantage
Plans generally don’t cover care outside of the U.S.