A Simple Guide To Comparing Medicare Plans
Medicare can feel like a different language. But if you know what a plan covers, which doctors and drugs it includes, and what you may pay, comparing options gets much easier.
Comparing plans
Start with your must-haves. Make sure any plan you’re considering includes your:
Providers
Prescriptions
Estimate your annual cost
Don't compare plans on premium alone. Also look at the deductible, copays, and coinsurance so you can estimate what you may spend over the full year.
Check the out-of-pocket maximum
The out-of-pocket maximum is your financial safety net. It's the most you'd pay in a plan year for covered, in-network services.
Review the rules
Plan rules can affect both cost and convenience. Pay close attention to:
Referrals for specialists
Prior authorization for certain services or drugs
Higher costs outside the network
Coverage Checkup, our comprehensive coverage recommendation tool, is designed to provide a personalized plan recommendation during Open Enrollment. Read Medicare Coverage Checkup Tool to learn more.
Avoid common plan mistakes
These are some of the easiest mistakes to make when you're comparing coverage:
Assuming a doctor is in-network
In network means the doctor, hospital, or pharmacy has a contract with the plan. Don't assume they're included just because you've used them before.
Covered services don’t mean no cost
Covered doesn't always mean free. You may still owe a deductible, copay, or coinsurance.
Prescription drug costs
Drug costs depend on the plan’s formulary and the pharmacy you use. This is especially important for brand-name and specialty drugs.
Missing prior authorization requirements
Prior authorization means the plan must approve some services, tests, or drugs before it'll help pay.
Mixing up plan year vs. calendar year
Know when your costs reset. Deductibles and out-of-pocket totals may restart each new plan year or calendar year, depending on how your coverage works.
Need a refresher on terms like premium, deductible, copay, coinsurance, formulary, or network? See Health Coverage Terminology Made Easy.