Medicare Decision Road Map

Here's a step-by-step list of the decisions you’ll need to make and what you’ll want to consider in order to make an informed choice.

1. Find out what Medicare plans are available in your area.

Reading this site is a good start, but you’ll want to learn more. Be proactive about investigating what’s available in your area. To find and compare plans in your area:

Talk to your family and friends about the Medicare coverage they have now. And if you have health care coverage through your employer, talk to your company benefits administrator about your choices.

2. Review your needs.

While you're doing your research, you'll want to think about what's important to you or your loved ones. Here are some questions to consider:

• What is most important to you in a Medicare health plan? (Think about cost, coverage, convenience and customer service)
• Are you eligible for any health care coverage other than Medicare, such as employer, retiree or union coverage through your or your spouse's employer? Will you want to keep that coverage?
• How much did you spend on health care last year? Do you expect similar costs this year?
• How much will you have to pay? Be sure to review all of the following:
• Monthly premiums
• Annual deductibles
• Copays or coinsurance for doctor visits
• Costs associated with emergency room and hospital stays
• Are there other health care expenses that you need to plan for (e.g., skilled nursing
  Nursing care that should be provided only by a licensed nurse.
  facility)?
• What is the limit on your out-of-pocket
  Indicates the amount you pay or others pay on your behalf toward the cost of your prescription drugs, including deductible, copays, coinsurance and payments made in the coverage gap. Premiums do not count toward out-of-pocket costs.
  costs per year (if there is one)?
• How does health care fit into your budget? Will you need financial help to pay for Medicare premiums?
• Are you in good health generally, or do you have chronic conditions such as diabetes, chronic heart failure or asthma?
• Does the plan meet your current medical needs?
• Which prescription drugs do you take regularly?
• How much do you spend on a 30-day supply of your prescriptions?
• Are your prescriptions included in the plans' drug list?
• Which doctors and hospitals do you use?
• Do they accept the plan you are considering?
• Is your doctor/specialist in the plan's network (if there is one)?
• Are you willing to change doctors to save on your health care costs?
• Will you need a referral to visit specialists?
• How much do you travel, and where? Do you need coverage for traveling out of state or overseas?

3. Look for a good fit for yourself or your loved one.

There's no "one size fits all." You have choices:

• Do you want only Original Medicare (Part A and Part B)?
• How about Original Medicare with a standalone Medicare Prescription Drug plan (Part D) or a Medicare Advantage plan (Part C)?
• Or perhaps you'll need a Medicare supplement insurance (Medigap) plan to help pay for the expenses Original Medicare doesn't cover?
• If I get a Medicare Advantage plan, do I want it with or without prescription drugs?

4. Ask for help if you need it.

You can get help in comparing and choosing Medicare plans.

For example, financial assistance programs are available to help with the costs of Medicare for those with lower incomes. If you think you might qualify, apply as soon as you can. It can take several months to process your application, and you'll want to find out if you're eligible and how much help you qualify for.

5. Act quickly.

Don't miss your Initial Enrollment Period (IEP). For most, your IEP begins three months before the month you turn 65, runs through your birth month and ends three months after your birth month.

• Make sure your Medicare coverage begins when you want it to begin.
• Avoid paying more in premiums because you waited.

You can also view a Road Map to help guide you through enrollment for your specific situation.