Choosing or Changing Medicare Coverage

by Mary Jane Stern

8 Things to Consider When Choosing or Changing Your Coverage

1)    Coverage–

a)     Are the services you need covered?

2)    Your other coverage

a)     If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare.

b)    If you have employment-related coverage, or get your health care from an Indian Health or Tribal Health Program, talk to your benefits administrator, insurer, or plan before making any changes.

3)    Costs

a)     How much are your premiums, deductibles, and other costs?

b)    How much do you pay for services like hospital stays or doctor visits?

c)     Is there a yearly limit on what you could pay out of pocket for medical services?

d)    Make sure you understand any coverage rules that may affect your costs.

4)    Doctor and hospital choice

a)     Do your doctors accept the coverage?

b)    Are the doctors you want to see accepting new patients?

c)     Do you have to choose your hospital and health care providers from a network?

d)    o you need to get referrals?

5)    Prescription drugs

a)     What are your drug needs?

b)    Do you need to join a Medicare drug plan?

c)      Do you already have creditable prescription drug coverage?

d)    Will you pay a penalty if you join a drug plan later?

e)     What will your prescription drugs cost under each plan?

f)     Are your drugs covered under the plan's formulary (drug list)?

6)    Quality of care

a)     The quality of care and services given by plans and other health care providers can vary.

b)    See the "Resource Locator" for more help comparing plans and providers.

7)    Convenience

a)      Does the plan include the doctors you see and the pharmacies you use?

b)    Can you get your prescriptions by mail?

c)     Do the doctors use electronic health records or E-prescribe?

8)    Travel

a)     Will the plan cover you if you travel to another state?


Every year your Medicare plan is required to send you the Evidence of Coverage (EOC) and Annual Notice of Change (ANOC)

The EOC gives you details about what the plan covers, how much you pay, and more.

The ANOC includes any changes in coverage, costs, or service area that will be effective in January.

If you don't get an EOC or ANOC, contact your plan.

5 Responses

  1. [...] This post was mentioned on Twitter by Dale Carter, Laurel Kennedy. Laurel Kennedy said: Choosing or Changing Medicare Coverage - by Mary Jane Stern 8 Things to Consider When Choosing or Changing Your Co... [...]
  2. My mother is in a nursing home-and I am the Medical POA. Do I make a decision about her medical coverage or does the nursing home? What is the procedure? Thanks for the help
  3. I would also suggest talking with your physician and go over my health care and prescription needs.
  4. I would also suggest talking with your doctor and go over your healthcare and presciription needs
  5. Having had to do this research for my mother, it is a complex and confusing process. This goes through all the things that you need to think about and explains it all clearly.
  6. It was nice to seethe process on one page and I found it easy to understand.