Understanding Your Health Care Needs

You may have many options when it comes to your Medicare coverage. How do you begin to narrow your choices so you can make an informed decision?

Your Medicare choices need to reflect your personal health care needs. Once you have a handle on that, the rest may begin to fall into place. Answering a few questions in the categories below is a good place to start.


How You Use Health Care

  • Question:

    How often do you visit the doctor, in general?

    Frequent doctor visits can get costly. 

    • With Original Medicare, you pay 20% of the allowed amount for most doctor services after you meet the Part B deductible. 
    • With most Medicare Advantage plans, you pay a small co-payment for each visit after you meet the Part B deductible. 
    • With either type of coverage, you also pay the monthly Part B premium to Medicare.
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  • Question:

    What prescription medication do you regularly take? 

    Most prescription drug plans and Medicare Advantage plans that include drug coverage have a drug list, or formulary. If your drugs are not on your plan’s formulary, you may have to pay more. Look for a plan that covers the drugs you take. Sometimes a plan will cover a similar medication that you can substitute.
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  • Question:

    What did you pay out-of-pocket for health care over the past 12 months? What did you pay for your prescription drugs? 

    It’s important to understand your out-of-pocket health care costs so you can compare what you’re paying now with what you might pay with a different plan.
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Confused about what might be right for you?

Examples may help. See how other people chose Medicare coverage to meet their needs. Your situation may be similar.

View Medicare plan examples... >

Your Preferences 

  • Question:

    Do you have a particular doctor, hospital or pharmacy that you use?

    Many Medicare Advantage plans contract with a network of providers and pharmacies to get special pricing. Plan members pay less out-of-pocket for care and services they receive from network providers. If your preferred provider or pharmacy is not in the network, you may pay more for the same care and services. With Original Medicare, you can use any provider or pharmacy in the country.
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  • Question:

    Does your doctor accept Medicare Assignment?

    Some doctors may charge more than Medicare’s allowed amounts for some services. The additional cost is referred to as excess charges. Doctors who do not accept Medicare assignment may bill you for excess charges.
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Your Health

  • Question:

    How is your health, in general? Has it changed recently, such as receiving a new diagnosis? Do you have any planned surgeries or procedures coming up?

    A change in your health status could mean that you will require more care and services in the future. Understanding the care and services you may need will help you compare Medicare coverage choices. Your doctor may be able to help you with this.
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  • Question:

    Do you have a chronic condition such as diabetes or congestive heart failure?

    Chronic conditions may require regular health care with frequent visits to doctors or specialists. Look for coverage choices that cover the care you need at a cost you can live with. Sometimes a Medicare Advantage Special Needs Plan can be a good fit in this kind of situation.
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  • Question:

    Do you have the last stage of kidney failure, known as End Stage Renal Disease (ESRD)?

    People with ESRD generally can’t enroll in a Medicare Advantage plan and must stay with Original Medicare.
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Your Life Situation

  • Question:

    Do you have other health coverage, such as through your or your spouse's current employer?

    Many people who have employer or union health insurance enroll in Medicare Part A and refuse Part B. Part A is premium free for most people and will cover hospital expenses as secondary insurance. Part B charges a premium, which you can avoid paying until you need the coverage—without penalty as long as you qualify for a Special Enrollment Period. Also, you can delay getting prescription drug coverage without penalty if you have creditable coverage through another source.
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  • Question:

    Do you travel frequently or live part of the year in a different state?

    Many Medicare Advantage plans contract with a network of providers and pharmacies within a geographic service area to get special pricing. Plan members pay less out-of-pocket for care and services they receive from network providers. You may pay more if you need services while traveling. Original Medicare provides coverage nationwide.
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  • Question:

    Do you have retiree health care coverage, such as through a union, the military or a former employer?

    It’s important to talk to your plan administrator about how your plan may work with Medicare before you make any decisions. You may have more options than the usual ones.
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  • Question:

    Do you live in long term care residence or skilled nursing facility (nursing home)?

    Medicare limits the number of days it will cover for care in a nursing home. You’ll need to figure out whether your care will be covered under different plan choices, for how long and at what price.
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Turning 65?

Now’s the time to prepare for your initial enrollment in Medicare.  See UnitedHealthcare plans in your area at UHCMedicareSolutions.com or call UnitedHealthcare 7 days a week from 8a.m.- 8p.m. local time at 1-866-584-6886 TTY:711.