7 Questions to Ask When Choosing a New Medicare Plan

Posted by John David Hrab, RN
Estimated Reading Time 2 minutes 2 seconds

Choosing a Medicare plan is one of the most important decisions you will make as you enter retirement or evaluate your healthcare options for the coming year. With multiple choices and varying coverage levels, it’s easy to feel overwhelmed. The good news is that by asking the right questions, you can make a confident and informed decision that aligns with your healthcare needs and financial goals.

Here are some key questions to consider when selecting a Medicare plan.

What are my current healthcare needs?

Start by assessing your current health status. Do you have any ongoing conditions that require regular doctor visits, prescriptions, or specialist care? Understanding your medical needs will help you determine whether Original Medicare or a Medicare Advantage plan will offer better support.

Are my doctors and hospitals covered?

Not all Medicare plans include the same network of providers. If you want to continue seeing your current doctors or visit a specific hospital, make sure they accept the plan you’re considering. This is especially important with Medicare Advantage plans, which often have limited provider networks.

What are the total costs?

It’s important to look beyond the monthly premium. Consider your deductible, copayments, coinsurance, and out-of-pocket maximums. A plan with a low premium might end up costing you more if it has high out-of-pocket expenses. Choose a plan that balances monthly cost with your expected medical usage.

Does the plan include prescription drug coverage?

If you take regular medications, make sure the plan includes Part D prescription drug coverage or that your drugs are covered under a Medicare Advantage plan. Review the plan’s formulary to ensure your medications are listed, and check whether there are any restrictions such as step therapy or prior authorization.

Are additional benefits included?

Some Medicare Advantage plans offer extra benefits like vision, dental, hearing, fitness memberships, or transportation services. While these benefits are not essential for everyone, they can add meaningful value depending on your lifestyle and health needs.

How Does the Plan Handle Referrals and Specialist Visits?

Some plans require you to get a referral from a primary care doctor before seeing a specialist. If you prefer more flexibility, you may want to choose a plan that allows direct access to specialists.

What do the star ratings and reviews say?

Medicare Advantage and Part D plans are rated by Medicare using a five-star system. These ratings reflect member satisfaction, quality of care, and customer service. Higher-rated plans may indicate a better experience overall.

Need Help Learning About Your Options?

Choosing the right Medicare plan involves careful thought and comparison. Your health, budget, and personal preferences all play a role in making the best choice.

Contact our licensed insurance brokers for expert guidance on selecting a Medicare plan that fits your needs. We’re here to make the process easier and help you feel confident in your coverage.