5 Proven Tips for Researching Medicare Benefits

When Susan Cirullo was preparing to retire 13 years ago, she had a clear idea of ​​how she would spend her golden years: traveling, playing golf, and hopefully spoiling future grandchildren. Staying active would be an essential part of a dream retirement for former health and physical education teacher. And so would choose the right health plan.

Susan retired several years before she was eligible to enroll in Medicare. In the meantime, she was covered by a group retirement plan that allowed her to “test drive” her benefits. When she first started qualifying for Medicare, she already knew what she wanted from a plan. Still, she did a fair share of research before making her decision, and she feels doing so is a better reason why she remains so pleased with her coverage. Susan has been a member of Aetna since 2014.

Given Susan’s excellent track record, we asked her if she had any tips to help newly qualified people as they research Medicare benefits. She read on to learn the secrets of her success.

1. Get to know yourself

As a resident of Pennington, New Jersey, Susan knew her retirement schedule would include extensive travel. “We had a second home in Maine when I retired,” he explains. “I wanted to make sure whatever insurance I chose would cover me in both places.” With some Medicare plans, network doctors are not available outside of your home state. But thanks to Susan’s foresight of her, she was recently able to join some school friends on a fly-fishing trip in Montana without having to worry about coverage.

Some lifestyle choices influence the type of benefits you need. Before you start researching coverage, make a list of your retirement goals. This will give you an idea of ​​which plans have all or most of what you need. Some questions to ask yourself include the following:

  • Do you expect to travel? If you have a family or vacation home in another state, you may want to explore coverage options in that area. If you like to travel outside the country, ask about coverage for emergency care abroad.
  • Go to the gym? Certain plans offer gym memberships.
  • Do you take maintenance medications? Some plans offer prescription drug coverage, but not all. You may need to purchase a separate plan.
  • Do you see different doctors? You may want coverage for out-of-network providers in case of unexpected health problems.
  • Do you have a chronic illness? Some plans offer special programs for chronic disease management.

Susan doesn’t plan to slow down anytime soon. “I have been blessed with good health and I want to keep it that way,” she says.

2. Learn about the benefits you can choose from

Susan walks daily and plays golf regularly. She wanted a plan that supported her active lifestyle and promoted her preventive care. That meant familiarizing yourself with the variety of benefits available. Susan recommends researching the basics first: doctor visits, hospitalization, and drug coverage. Then look for convenient perks like nutritional counseling or a 24-hour nurse helpline.

Get comfortable with the alphabet soup of Medicare coverage: Parts A, B, C, and D. Understand what each covers: hospital stays (Part A), doctor visits (Part B), and drugs (Part D; more details in the next section). Know that some plans, like Medicare Advantage (also called “Part C”), cover extra benefits, like dental, vision, hearing, and gym memberships. Keep a cheat sheet handy if you have trouble remembering which is which.

3. Consider prescription drug benefits (even if you don’t need them now)

Susan currently takes only one prescription medication, but she knows this could change. So she chose a plan with prescription drug coverage. A 2019 AARP survey reported that 80% of respondents over the age of 50 take prescription medications regularly, and 72% said they are concerned about the cost of their medications.

While most employer-sponsored health insurance plans include prescription drug benefits, Medicare is different. When you join Original Medicare, you need to buy a separate drug plan. By contrast, most Medicare Advantage plans include prescription drug benefits.

Susan warns against opting for a prescription drug plan. Even if she is not taking any medication now, the future is hard to predict. Also, not choosing drug coverage when you first sign up for Medicare can lead to penalties if you sign up later.

4. Know how much you can spend on health care

As a former state employee, Susan receives a pension. She may pay a little more for a plan with a low limit on annual out-of-pocket costs. This will protect her finances if she later develops a serious (and expensive) illness.

Budgeting for health care is an important part of planning for retirement. Remember that some plans may cost more upfront, but offer benefits that can save you money over time. When researching Medicare plans, be sure to consider the following things:

  • The premiums you will pay for the different parts of Medicare.
  • The cost of regular doctor visits and prescription drugs.
  • The plan’s deductibles and out-of-pocket maximums.

If you feel anxious just mentioning “deductibles” or “out-of-pocket maximums,” it may be time to brush up on insurance terminology. The “deductible” is the amount you must pay for health services or prescription drugs before your insurance plan begins to pay. The “out-of-pocket maximum” is the most you can expect to pay during a policy period (usually one year) for covered medical services. Once you reach the maximum, your plan pays 100% of covered medical services. Learning the garden will help you make informed decisions about the plan that best suits your health needs and budget.

5. Evaluate if it is important to keep your doctors current

Susan had been seeing the same doctors for years by the time she retired. They knew her background her and she felt comfortable in their care of her. I didn’t want to lose those relationships if they were no longer part of the network. So Susan made sure she would have access to the same doctors with her new Medicare plan.

Susan admits that she wasn’t always able to examine her benefits so carefully. Several years ago, she lost her husband, William, to cancer. When she was in treatment, Susan didn’t have time to think about anything else. She just wanted to know he had coverage so she could focus on taking care of him.

If you’re in a similar situation, you might consider a plan that allows you to get access to doctors and hospitals outside the network. This will allow you to focus on the most important issues.

Ultimately, Susan chose a Medicare Advantage plan because it supported all of her goals in one plan. Your early research continues to pay dividends. Not only is she still healthy and active, but she believes her decision to focus on maintaining her health is setting a positive example for her granddaughters. “I have two granddaughters now,” says Susan. “I want them to grow up to be healthy women because they had such fantastic role models.”