Some seniors aren’t sure where to start when choosing a Medicare health plan. Getting a plan that makes sense for you is another good opportunity to stay your healthiest — all it takes are a few questions.
Whether you choose Original Medicare or enroll in a Medicare Advantage plan, some levels of coverage will be similar. A Medicare Advantage plan may offer added benefits like vision and dental. A Medicare Advantage plan can also provide the financial security of an annual maximum out-of-pocket limit on what you pay for covered services in a plan year.
5 questions to help you decide:
1. How much coverage do I want?
If you’re looking for basic coverage, Original Medicare may be enough. It offers a combination of hospital and medical insurance (Parts A and B). To get help paying for prescriptions, you’ll also need a stand-alone prescription drug plan (Part D).
Medicare Advantage (Part C) plans include the basic coverage and may include extra benefits like fitness, dental, vision, hearing, and travel benefits that aren’t offered by Original Medicare. Most Medicare Advantage plans also include prescription coverage.
2. Does this plan fit my health and finances?
Look carefully at the costs of each plan, including premiums, deductibles, copays, and coinsurance. How much will you pay for X-rays, outpatient surgery, and inpatient hospital care? Unlike Original Medicare, is there a yearly limit on out-of-pocket costs? And, most importantly, consider what makes sense for your health and finances.
3. What is the coverage for my prescription drugs?
Each health plan that offers prescription drug coverage includes a drug formulary — their list of covered medications. Are the prescriptions you’re currently taking listed on the formulary? How much will you pay for brand-name and generic drugs?
4. Are there extra benefits I would use?
Check to see if the plan provides fitness, dental, vision, and hearing benefits. You may also find health and wellness programs, transportation, and travel benefits. You won’t find extra benefits like these with Original Medicare, but they’re often included as part of Medicare Advantage plans, and they vary by plan.
5. What is the plan’s quality rating?
The Centers for Medicare & Medicaid Services evaluates the quality of Medicare Advantage plans every year, and their ratings give you an easy way to compare plans. A 5-Star rating indicates an excellent rating. You’ll find the most up-to-date ratings on Medicare.gov or by calling 1-800-633-4227 (TTY 1-877-486-2048), 24 hours a day, 7 days a week.
The Medicare Advantage (HMO) plans at Kaiser Permanente Washington are rated 5 out of 5 Stars for 2022.1
You can call a Kaiser Permanente Medicare specialist who can personally guide you every step of the way at 1-877-448-3086 (TTY 711), seven days a week, 8 a.m. to 8 p.m. Or visit kp.org/wa/spokesman.
Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.
1 Every year, Medicare evaluates plans based on a 5-star rating system.
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