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 Medicare Advantage and Medicare Supplement plans, 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). But it’s important to remember 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 three main options:
- You can choose to sign up for Original Medicare
- You can choose to sign up for a Medicare Advantage plan, such as one of Tufts Health Plan’s HMO or PPO plans
- You can choose to sign up for 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. To have enough coverage, many people choose to enroll in a Medicare Advantage plan or a Medicare Supplement plan.
What are the advantages of a Medicare Advantage plan?
Medicare Advantage plans cover everything Original Medicare covers plus they include additional benefits. Medicare Advantage 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.
Tufts Health Plan offers both HMO and PPO Medicare Advantage plans. With an HMO plan, you have the benefit of a primary care physician, or PCP, who coordinates your care and can refer you to specialists as needed. With a PPO plan, you have the flexibility to visit any doctor, even those outside the plan network.
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 Medicare Advantage plans, but you can see any doctor who accepts Medicare.
If you want prescription drug coverage, you would need to purchase a separate prescription drug plan (it’s not included with a Medicare Supplement plan).
How do I know which plan option is the right fit?
When deciding whether to choose a Medicare Advantage 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 a Medicare Advantage plan than with a Medicare Supplement plan, but with a Medicare Supplement plan, fewer services require a copayment. Also worth considering is that Medicare Advantage plans provide what’s known as an out-of-pocket maximum that protects you by limiting the amount you 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, whereas a PPO plan means you can see any doctor but are responsible for coordinating your own care. With a Medicare Supplement plan, you don’t have a PCP, but you can see any doctor who accepts Original Medicare.
- Drug Coverage – With a Medicare Advantage plan, you can have Part D prescription drug coverage and medical coverage all in the same plan. With a Medicare Supplement plan, if you want prescription drug coverage, you would need to enroll in a separate prescription drug plan.
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?
Tufts Health Plan is the only plan in Massachusetts rated 5 out of 5 Stars for eight years in a row, 2016-2023, by the Centers for Medicare and Medicaid Services. That's because we know nothing is more important than your health.
We have a team of Medicare Experts who are local and available to answer all your Medicare questions and help you find the plan that’s right for you. Tufts Health Plan offers Medicare Advantage HMO plans, a Medicare Advantage PPO plan, and Medicare Supplement plans.
Call 1-844-455-3303 (TTY: 711) to chat with us, or click the button below for other simple ways to enroll: Ways to Enroll
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.