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Real Life Medicare Examples

See how four different people chose their plans.

Medicare offers a lot of choices. You’ll need to compare your needs with the plans that are available where you live.

It can help to see examples of what other people decided and why.

David's Story 65 and retired
Juanita's Story Turning 65 and looking forward to traveling in retirement
Georgia's Story Limited income and specialist needs
Leroy's Story Serious health problems and multiple medications
Ann's Story 70-something and disabled with a very low income
Frank's Story Disabled, low income and hoping to live independently
David Juanita Georgia Leroy Ann Frank
David

David just turned 65 and is already retired. He’s in good shape and generally healthy. He takes a daily prescription drug to keep his high blood pressure in check. The drug currently costs him about $90 each month. David takes good care of himself. He 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 additional medications in the future

David's Choice

plan choices

Health Maintenance Organization (HMO) Medicare Advantage plan with built-in prescription drug coverage. To qualify for this plan, David must be enrolled in Medicare Part A and Part B. He will continue to pay the Part B premium to Medicare.

Plan Features

  • Preventive care
  • Network of local doctors and hospitals
  • Free fitness program
  • Built-in prescription drug benefit

Plan Costs (2015 amounts)

$104.90
per month
Part B premium (The Part B premium may be automatically deducted from your Social Security check.)
$0
per month
Medicare Advantage premium (includes prescription drug coverage)*
 
 
Other costs: David’s out-of-pocket costs include copays or coinsurance based on the type and amount of services he uses and drugs he takes.

$104.90
per month
Total costs

*Cost shown is for illustration only. Your costs may be different.
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 help paying her costs if they are high

Juanita's Choice

plan choices

Original Medicare Parts A and B plus a standalone Medicare Part D prescription drug plan and a Medicare supplement insurance plan (Medigap) plan F

Plan Features

  • Access to doctors and hospitals that accept Medicare patients throughout the United States
  • Discounted prices on the drugs she takes
  • Help with her Original Medicare deductibles and coinsurance

Plan Costs (2015 amounts)

$104.90
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*
 
 
Other costs: Juanita’s Medicare supplement insurance plan covers most of her out-of-pocket costs with Original Medicare. She makes copayments and pays other costs associated with her drug plan. She also must pay any out-of-pocket costs not covered by her supplement insurance.

$282.40
per month
Total costs

*Cost shown is for illustration only. Your costs may be different.
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

  • Access to her trusted doctors
  • Health care at an affordable price
  • Discounted prices on her prescription drugs

Georgia's Choice

plan choices

Original Medicare Parts A and B plus a standalone Medicare Part D prescription drug plan

Plan Features

  • Access to the doctors and hospitals she uses now
  • The possibility of help with her premiums and cost sharing if she qualifies for low-income assistance

Plan Costs (2015 amounts)

$104.90
per month
Part B (If you receive Social Security, this will be deducted from your check automatically.)
$20.50
per month
Medicare Part D prescription drug plan premium*
 
 
Other costs: Georgia pays copays or other costs associated with her drug plan. She also must pay all costs not covered by Original Medicare. If Georgia qualifies for financial help, her out-of-pocket costs may be greatly reduced.

$125.40
per month
Total costs

*Cost shown is for illustration only. Your costs may be different.
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

plan choices

Medicare Advantage Special Needs Plan (SNP) for people with diabetes, with built-in prescription drug coverage. To qualify for this plan, Leroy must be enrolled in Medicare Part A and Part B. He will continue to pay the Part B premium to Medicare.

Plan 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

Plan Costs (2015 amounts)

$104.90
per month
Part B premium (If you receive Social Security, this will be deducted from your check automatically.)
$24.00
per month
Medicare Advantage Special Needs Plan premium*
 
 
Other costs: Leroy will have out-of-pocket costs as determined by the plan. His total spending will depend on the type and amount of services he uses and drugs he takes.

$128.90
per month
Total costs

*Cost shown is for illustration only. Your costs may be different.
Ann

Ann and her former husband lived paycheck to paycheck and were unable to save for retirement. Now in her 70s, Ann has a very low income. She was recently diagnosed with type 2 diabetes. Living month to month is stressful. Now she has a new health condition to manage.

Ann's Wish List

  • A plan that’s easy to understand
  • Help understanding and managing diabetes
  • Coverage for her current medications and diabetes testing supplies
  • Access to the doctors and hospitals she currently uses

Ann's Choice

plan choices

A Medicare Advantage Dual Special Needs Plan (DSNP). Ann qualifies for this plan because she is dual eligible A person who is eligible for both Original Medicare (Parts A and B) and Medicaid. . Her age makes her eligible for Medicare. Her low income makes her eligible for Medicaid, a state health insurance plan. With the DSNP, Ann will get even more benefits than she was receiving from separate Medicaid and Medicare plans.

Plan Features

  • $0 cost for diabetes testing supplies
  • Credit toward the purchase of everyday health care products such as toothpaste, non-prescription drugs and daily vitamins

Plan Costs (2015 amounts)

$0
per month
Dual Special Needs Plan premium
 
 
* Ann’s costs may be as low as $0, depending on her level of Medicaid eligibility.

$0.00
per month
Total costs

*Cost shown is for illustration only. Your costs may be different.
Frank

Frank suffered a traumatic brain injury in a car accident when he was 28. He’s now 30. His condition has improved, but Frank still battles depression and short-term memory loss. Frank’s disability and limited education make it hard to find a job. His finances are tight. Frank hopes to live independently in the future.

Frank's Wish List

  • A low copay for prescription drugs
  • Help with rent and living expenses
  • Mental health services
  • Access to the doctors and hospitals he uses now

Frank's Choice

plan choices

A Medicare Advantage Dual Special Needs Plan (DSNP). Because of his low income and disability, Frank is dual eligible A person who is eligible for both Original Medicare (Parts A and B) and Medicaid. . He will get benefits from both Medicaid and Medicare plans. Frank needs to enroll in Part A and Part B to be eligible for a DSNP plan.

Plan Features

  • Ability to see any doctor without a referral
  • Prescription drug coverage
  • Outpatient mental health services

Plan Costs (2015 amounts)

$0
per month
Dual Special Needs Plan premium
 
 
* Frank's costs may be as low as $0, depending on his level of Medicaid eligibility.

$0.00
per month
Total costs

*Cost shown is for illustration only. Your costs may be different.