How to Choose the Right Medicare Plan: An Interview With a Tufts Health Plan Medicare Expert
Choosing a Medicare plan can feel overwhelming. With so many options, how do you know which plan is right for you?
Christine has been a Medicare Expert with Tufts Health Plan for over 20 years. She is committed to helping people find the right plan and has extensive knowledge about how Medicare works. We recently spoke to her about Medicare plan options, the differences between an HMO plan and a Medicare Supplement plan, why Original Medicare may not offer enough coverage, and more.
What happens when I turn 65?
When you turn 65, you are eligible to receive Original Medicare, which is provided by the Federal government. Original Medicare includes Part A hospital coverage and Part B medical coverage. It’s important to remember, however, that Original Medicare doesn’t provide Part D prescription drug coverage. Also, many people don’t realize that Original Medicare only covers 80% of expenses. The remaining 20% is your responsibility and could add up to thousands of dollars each year.
What choices do I have for Medicare plans?
While it may seem like there are a lot of decisions to make when choosing a Medicare plan, there are only 3 main options:
- You can stay on Original Medicare
- You can choose a Medicare Advantage plan (such as an HMO plan)
- You can choose a Medicare Supplement plan
Why is it that Original Medicare may not provide enough coverage?
With Original Medicare, there are gaps in your coverage. For example, Original Medicare has deductibles and does not have a limit on out-of-pocket spending. Original Medicare doesn’t cover Part D prescription drugs, routine vision and hearing exams, and certain other services. In order to have enough coverage, many people choose to enroll in an HMO plan or a Medicare Supplement plan.
What are the advantages of an HMO plan?
Many people choose an HMO plan because it covers everything Original Medicare covers plus additional benefits. HMO plans generally have lower monthly premiums than Medicare Supplement plans and are available with prescription drug coverage, so you can have medical and drug coverage in one plan. With an HMO plan, you have a primary care physician, or PCP, who keeps track of all your care and refers you to specialists. With an HMO plan, you have a team behind you to make sure you get the right care.
What about a Medicare Supplement plan?
A Medicare Supplement plan will help cover gaps in Original Medicare. Generally, Medicare Supplement plans have higher monthly premiums than HMO plans, but you can see any doctor who accepts Medicare. Although, with a Medicare Supplement plan, you would need to purchase a separate prescription drug plan if you want prescription drug coverage.
How do I know which plan option is the right fit?
When deciding whether to choose an HMO plan or a Medicare Supplement plan, I think it’s helpful to consider several factors:
- Your health – How many times a year do you visit a doctor, specialist, or hospital? If you are in good health, you may want to consider a plan with a $0 or low monthly premium. If you see your doctor more frequently, you may want a plan with a higher monthly premium in exchange for lower doctor visit copays.
- Your budget – Do you want to pay less each month or pay less when you visit a doctor? You’ll want a plan that provides you with the right amount of coverage and still meets your budget. Generally, you’ll pay lower monthly premiums with HMO plans than with Medicare Supplement plans, but with Medicare Supplement plans, fewer services require a copayment. Also, worth considering is that HMO plans provide what’s known as an out-of-pocket maximum that protects you by limiting the amount you would have to spend on medical costs in a year. With Original Medicare and Medicare Supplement plans, there is no limit to how much you may have to pay out of pocket in a year.
- Your doctor – Choosing an HMO plan means you have a PCP who works together with a team of specialists to help you stay healthy and get the care that is right for you. With a Medicare Supplement plan, you don’t have a PCP, but you can see any doctor that accepts Original Medicare.
- Drug coverage – With an HMO plan, you can have Part D prescription drug coverage and medical coverage all in one plan. With a Medicare Supplement plan, if you want prescription drug coverage, you would need to enroll in a separate prescription drug plan.
But, no matter which plan you choose, it’s important to sign up for prescription drug coverage when you are first eligible to avoid paying a penalty assigned by Medicare.
What if I have additional questions?
At Tufts Health Plan we have a team of Medicare Experts available to answer all your Medicare questions and help you find the plan that’s right for you. Tufts Health Plan offers both HMO plans and Medicare Supplement plans. Just call 1-844-455-3303 (TTY: 711).
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Every year, Medicare evaluates plans based on a 5-Star Rating System. Visit medicare.gov for more information. Tufts Health Plan Medicare Advantage (HMO) plans received 5 out of 5 Stars for contract years 2016, 2017, 2018, 2019, 2020, 2021, 2022, and 2023.