Choosing a Medicare Plan: How Juanita Decided

Medicare offers a lot of choices. Does Original Medicare Parts A and B provide the coverage you need? What options are available to help with expenses like deductibles and prescription drug coverage? It might be helpful to make a list of your most important coverage needs before you research or enroll in a plan. Then you can compare those needs with what’s available in your area. In this post, you’ll meet Juanita1and learn why a combination of plans met her specific needs.

About Juanita

Juanita will be 65 in three months. This means her Medicare Initial Enrollment Period has just started. When she turns 65, she plans to retire. This will give her the freedom to spend a lot of time out-of-state visiting her children and grandchildren in California. Juanita is in good health, although she takes one drug to keep her bones strong and another to keep her cholesterol levels in check. Juanita has a comfortable pension, but she wants to leave a financial legacy to her family.

Juanita’s Medicare Wish List

  • Flexibility to visit doctors and hospitals when she’s out of state visiting her family
  • Help paying for her prescription drugs
  • Significant help paying for extra out-of-pocket costs if they’re large

Juanita’s Choices – A Combination of Plans

Juanita actually chose three different Medicare plans to meet her specific needs: Original Medicare (Part A and Part B), a standalone Part D prescription drug plan. Rounding out her choices was a Medicare supplement insurance plan.

Original Medicare, consisting of Part A and Part B, provides the medical and hospital coverage Juanita wanted. Part A is generally thought of as “hospital insurance.” It pays for hospital stays and follow-up care in a skilled nursing facility, as well as some home health care services and hospice care. Part B helps pay Juanita’s doctor bills, including doctor office visits, most preventive care and many lab tests and screenings. A standalone  Medicare Part D prescription drug plan helps Juanita pay for prescription drugs. Her  Medicare supplement insurance (Medigap) plan will help pay out-of-pocket expenses the other plans won’t cover.

Why was this combination of plans a good choice for Juanita?

  • Original Medicare gave her access to doctors and hospitals throughout the United States
  • A standalone Part D prescription drug plan offered discounted prices on the drugs she takes
  • A Medicare supplement insurance plan provided help with her Medicare Part A and B deductibles and coinsurance

Cost Sharing

The premiums Juanita will pay include a monthly Part B premium, a monthly Medicare Part D prescription drug plan premium and a monthly Medicare supplement insurance premium.

Her Medicare supplement insurance plan will help pay for most of the out-of-pocket expenses not covered by Original Medicare Parts A and B. Juanita pays for her drug plan cost sharing and any costs not covered by her Medicare supplement insurance plan. Remember: this is just an example. For plans outside of Original Medicare Parts A and B, costs can vary from plan to plan. Contact the plan you’re interested in to see what your costs might be.

Make an Informed Decision

Juanita did her homework and got what she needed with a combination of Medicare plan options. It’s a good idea to understand all the parts to Medicare and research specific plan types and combinations. That way, when it’s time to make your plan selection, you can make an informed, confident choice.

1 Fictional character created to show a specific set of Medicare needs and coverage options.

–This information was provided by Medicare Made Clear

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