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Choosing the right Medicare plan is one of the most important decisions you’ll make as you approach retirement age, or even after you’re already enrolled. With so many plan types, coverage options, and benefits to consider, it can feel overwhelming. But don’t worry, you don’t have to figure it out alone. Whether you’re turning 65, recently retired, or simply exploring new options, here’s a helpful guide to get you started in choosing the Medicare plan that fits your life, health needs, and budget.
Know Your ABCs (and Ds) of Medicare
Medicare has several “parts,” and understanding them is the first step:
- Part A covers hospital care
- Part B includes outpatient and doctor visits
- Part C (also known as Medicare Advantage) is a bundled alternative that usually includes Parts A, B, and D
- Part D helps pay for prescription drugs.
Medicare Supplement Plans (Medigap) help fill in the gaps in Original Medicare coverage. Each of these options serves different needs, and the good news is, you have choices!
Original Medicare vs. Medicare Advantage:What’s the Difference?
Original Medicare allows you to visit any doctor or hospital in the U.S. that accepts Medicare, without worrying about networks. It doesn’t include prescription drug coverage, but you can add a Part D plan and/or a Medicare Supplement (Medigap) plan to help cover costs. Key Points: No networks—freedom to choose providers. Can be paired with other coverage for added protection. You pay a monthly premium for Part B (about $185 in 2025). Medicare Advantage (Part C) is an all-in-one plan offered by private insurers. It must cover everything Original Medicare covers, and many plans also include extra benefits like dental, vision, hearing, and prescription drug coverage—all in one package. Key Points: Often includes prescription drug coverage. May include extra benefits not offered by Original Medicare. Requires use of in-network providers for most plans. Sets a cap on your annual out-of-pocket costs.
Understand the Costs Involved
When choosing a Medicare plan, it’s essential to understand the types of costs involved: Premium: Your monthly payment to keep the plan active. Deductible: What you pay before coverage kicks in. Copayment: A fixed amount you pay for a service or prescription. Coinsurance: A percentage of the cost you’re responsible for. Maximum Out-of-Pocket: The most you’ll spend in a year before the plan covers 100%. Medicare Advantage plans, in particular, offer peace of mind by capping your annual out-of-pocket spending.
Think About Your Current and Future Health Needs
Ask yourself: How often do I visit the doctor? Do I have chronic conditions that need regular management? Are there specific doctors or specialists I want to keep seeing? What prescriptions do I take regularly? These questions will help you determine which plan type will serve you best. For instance, if you have complex medical needs or take multiple prescriptions, it’s worth checking if your doctors and medications are covered under a specific plan.
Traveling? Don’t Forget About Coverage on the Go
If you love to travel, coverage matters. Original Medicare covers you anywhere in the U.S. and its territories, but not abroad. Some Medicare Advantage plans offer limited coverage for emergencies outside the U.S., so make sure to ask.
Big Changes for Prescription Drug Coverage in 2025
Great news for those taking medications: In 2025, the Part D coverage gap (donut hole) will be officially closed. After meeting your deductible, you’ll pay no more than 25% of drug costs until you reach an out-of-pocket maximum of $2,000. After that, your plan covers the rest. That’s huge savings for many Medicare beneficiaries!
How to Compare Medicare Advantage Plans
Once you know Medicare Advantage might be a good fit, it’s time to compare: Are your doctors and hospitals in-network? What’s the plan’s Star Rating (from Medicare)? Are your medications on the formulary? What’s the monthly premium? What are your expected copays, coinsurance, and deductibles? What’s the maximum out-of-pocket for the year? Medicare Star Ratings are based on quality and performance, including member satisfaction, customer service, preventive care, and drug safety.
Need Help Navigating Your Options?
I’m Here for You. Choosing a Medicare plan can be confusing, but the good news is it’s not permanent. Every fall, from October 15 to December 7, you can review and change your coverage during Medicare’s Annual Enrollment Period.
This article is for informational purposes only. Contact Myriam Villa Insurance for personalized guidance tailored to your needs.