1 1 home
Insurance > Medicare Basics

4 Steps to Consider Before Choosing Medicare

When it’s time to enroll in Medicare, you’ll have to make some choices about your health coverage. These steps may help you make decisions.

Before making any decisions about your Medicare coverage, make sure to learn about the differences in Medicare’s 4 parts.

How to Make the Best Decisions When Choosing Medicare
How to Make the Best Decisions When Choosing Medicare

Find out when you can get Medicare

Some people are enrolled in Medicare automatically. If you’re 65 years old and you’ve paid 10 years of Social Security taxes, then you may be automatically enrolled. If you are approaching 65 years of age and don’t know if you are eligible, call Social Security at 800-772-1213.

If you are not automatically enrolled, you can enroll for Medicare in your Initial Enrollment Period (IEP). The IEP lasts for 7 months, with the fourth month usually being the one in which you turn 65. (For example, if your 65th birthday is in June, your IEP begins March 1 and ends September 30.) However, if your 65th birthday falls on the first day of the month, your whole IEP moves forward. (In this case, if your birthday is June 1, your IEP begins February 1 and ends August 31.)

If you don’t enroll during your IEP, you may have to pay a Part B late enrollment penalty, and you may have a gap in coverage if you decide you want Part B later.

Focus on the questions that will help you choose the right plan

How sick or healthy are you? What can you afford to pay each month? Do you have money set aside for emergencies?

Original Medicare covers Parts A and B. You pay standard rates for services, regardless of where you live. Original Medicare allows you to go to any doctor, hospital, or other provider that accepts Medicare patients anywhere in the country.

Medicare Advantage delivers benefits through local or regional private plans, which are most often HMOs or PPOs. Each plan must include everything covered by Original Medicare, but may offer more benefits and/or lower copays.

Know your options for prescription coverage

To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. The costs and drugs covered vary from plan to plan. There are 2 ways to add drug coverage:

  • Medicare Part D plans add prescription drug coverage to Original Medicare
  • Medicare Advantage plans are private insurance plans, typically HMOs or PPOs

Understand your choices for coverage

If you choose Part A and Part B coverage, you can select how you want it. The choices are Original Medicare, or a Medicare Advantage Plan. Original Medicare is covered by the federal government and usually carries a cost for each service. Medicare Advantage Plans are generally an HMO or PPO. Some people also get additional coverage, such as Medigap.

Your Medicare Choices: Original Medicare or Medicare Advantage Plan
Your Medicare Choices: Original Medicare or Medicare Advantage Plan