Considering Medicare plan options can be confusing, whether you’re signing up for the first time or making a change during open enrollment. These questions can help you find the coverage that best fits your life, health, and finances.
Original Medicare offers a combination of hospital and medical insurance (Parts A and B). If you’re looking for basic coverage, that may be enough. A stand-alone drug plan (Part D) can help with prescription coverage.
If you are seeking more comprehensive care, you may want to consider Medicare Advantage plans (Part C), which provide hospital and medical benefits and may include Part D prescription drug coverage. Medicare Advantage plans may also include benefits like a fitness program, routine vision and hearing services, and other services not covered by Original Medicare. Medicare Advantage plans are provided by companies approved to participate in Medicare programs — including Kaiser Permanente, which offers a range of plans.
Each plan has different costs, including premiums, deductibles, copays, and coinsurance. If you are on an Original Medicare plan, you’ll need to reach a deductible each year before your plan begins to pay. You’ll usually pay 20% of the total cost of each service, including primary care doctor visits, and there is no limit to how much you’ll pay out of pocket each year. Many Medicare Advantage plans have zero-dollar premiums and typically offer low or no deductibles. Most plans also set limits on the maximum out-of-pocket costs you’ll pay during a plan year.
If you are on Original Medicare, you can see any doctor who accepts Medicare. With plans such as Kaiser Permanente’s Medicare Advantage HMO plan, you have access to a specific network of doctors and care providers, as well as hospitals, pharmacies, and other care facilities. By getting care in a coordinated network, you’ll have access to a care team dedicated to meeting your health care needs.
Health plans that offer prescription drug coverage have a list of covered medications. Consider the medication you’re currently taking or may need in the future. Is your medication on that list? Does the plan offer a convenient way to get your prescription? Kaiser Permanente provides mail-order delivery of up to a 3-month supply of medicine, arriving in as few as 1 to 2 days*, and delivery is free of charge.
Star quality ratings are a simple way to compare plans. These ratings are given out each year by the Centers for Medicare & Medicaid Services. They rate most Medicare Advantage and Medicare Part D drug plans. A 5-Star rating indicates the highest-rated plan. To find these ratings, use the plan finder tool at Medicare.gov or call 1-800-633-4227 (TTY 1-877-486-2048), 24 hours a day, 7 days a week.
Choose the right health plan for you
Choose a health plan that supports your total health. If you’re 65 or older, you may be eligible for Medicare. The open enrollment period is an opportunity for anyone eligible for Medicare to consider if their current health plan meets their needs. Every year, Medicare open enrollment runs from October 15 through December 7. If you are turning 65 or had another qualifying life event, such as moving, you can enroll during a special enrollment period. Take advantage of these times to ask about coverage details and compare plans.
There is a lot to consider. To learn more about Medicare, you can attend a Kaiser Permanente seminar in person or online, call a Kaiser Permanente Medicare specialist at 1-866-949-3145> (TTY 711), 7 days a week, 8 a.m. to 8 p.m., or visit kp.org/wa/medicarenews.
You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll. Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.
*For certain drugs, you can get prescription refills mailed to you through our Kaiser Permanente mail-order pharmacy. You should receive them within 3-5 days. If not, please call 1-800-245-7979.