Medicare offers a lot of choices. You'll need to compare your needs with what's available. Here are examples and reasons why they're a good fit. Remember, costs will vary and your costs may differ.
David
David just turned 65 and is already retired. He's in good shape but takes a daily prescription drug to keep his high blood pressure in check. The drug costs him about $90 each month. David takes good care of himself and is careful to live within his budget.
David's wish list
- Access to a full range of health care services, including preventive care
- Coverage that provides a safety net in case of a serious illness
- Access to specialists if he needs them; he's comfortable with sticking to choices in a plan's network
- Access to prescription drug coverage in case he needs to take more drugs later
David's choice
A Health Maintenance Organization (HMO) Medicare Advantage (Plan C) plan. To qualify for this plan, David must also have Original Medicare (Part A and Part B), and continue to pay his Part B premium.
Features:
- Preventive care
- Network of local doctors and hospitals
- Free fitness program
- Built-in prescription drug benefit
Cost sharing
Premiums: (2012 figures) $99.90 per month Part B premium (If you receive Social Security, this will be deducted from your check automatically.)
$0 per month Medicare Advantage premium (includes prescription drug coverage)
Total: $99.90 per month
Other cost sharing: David pays a copay or coinsurance based on the services he uses and the drugs he takes.
Juanita
Juanita will be 65 in three months. She plans to retire then and spend a lot of time out of state visiting her children and grandchildren in California. Juanita is in good health, although she takes a drug to keep her bones strong, plus another drug to keep her cholesterol down. Juanita has a comfortable pension, but she wants to leave a financial legacy to her family.
Juanita's wish list
- Access to doctors and hospitals when she's out of state visiting her children
- Help with paying for her prescription drugs
- Peace of mind of knowing that she will have significant help paying for her costs if they're large
Juanita's choice
Features:
- Access to doctors and hospitals throughout the United States
- Discounted prices on the drugs she takes
- Help with her Original Medicare deductibles and coinsurance
Cost sharing
Premiums: (2012 figures) $99.90 per month Part B premium (If you receive Social Security, this will be deducted from your check automatically.)
$27.50 per month Medicare Part D prescription drug plan premium
$150.00 per month Medicare supplement insurance plan "F" premium*
Total: $277.40 per month
*Hypothetical amount
Other cost sharing: Medicare supplement insurance plan covers most of Original Medicare cost sharing; Juanita covers drug plan cost sharing and the costs not covered by the Medicare supplement insurance plan.
Georgia
Georgia will be 65 next month. She has been working part-time since her husband died five years ago, but her income is limited. Georgia has heart disease, so she sees a heart specialist regularly and takes a blood-thinning medicine every day. She cannot afford a Medicare supplement insurance plan.
Georgia's wish list
- Health care at an affordable price
- Access to her trusted doctors
- Discounted prices on her prescription drugs
Georgia's choice
Features:
Cost sharing
Premiums: (2012 figures) $99.90 per month Part B premium (If you receive Social Security, this will be deducted from your check automatically.)
$20.50 per month Medicare Part D prescription drug plan premium
Total: $120.40 per month
Other cost sharing: Georgia pays drug plan cost sharing and all costs not covered by Original Medicare; if Georgia qualifies for financial help, her cost sharing could be significantly lower.
Leroy
Leroy is about to turn 65. He has had serious health problems for years. He suffers from diabetes and high blood pressure, and his doctor has told him he needs to lose a considerable amount of weight. Leroy takes insulin and blood pressure medication every day. He has had trouble in the past with interactions of the drugs he is taking.
Leroy's wish list
- Expert help with managing his health problems
- Help with improving his diet, exercise and weight management
- Discounted prices on prescription drugs
Leroy's choice
Features:
- Access to a care manager who will create a plan for coordinating his care
- Help with finding out if he qualifies for financial assistance with Medicare costs
- Discounted prices on the drugs he takes
- Help with adopting a healthier lifestyle
Cost sharing
Premiums: (2012 figures) $99.90 per month Part B premium (If you receive Social Security, this will be deducted from your check automatically.)
$24 per month Medicare Advantage Special Needs Plan premium
Total: $123.90 per month
Other cost sharing: Leroy pays his cost sharing as determined by the plan; total spending depends on services and drugs used.