7 considerations you should weigh when deciding on Medicare coverage


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We’re in the midst of a crucial time if you’re someone who needs to enroll for Medicare, the federal health insurance program for people 65 or older.

There are other instances in which someone younger might be on Medicare, but safe to say, you would know if those circumstances applied to you.

The annual enrollment period, or AEP, is underway right now, which is when decisions need to be finalized.

This year, that deadline is Dec. 7. So needless to say, if any of this applies to you so far, you’re on the clock.

The experts at Simply Healthcare, along with Medicare.gov, want you to think about these seven things when choosing your coverage.

So if you’re not sure where to start or how to enroll, you might want to start by thinking about …

The costs

You want to take into consideration items including premiums, deductibles and other costs.

  • How much would you pay for services including hospital stays or doctor visits?
  • Is there a yearly limit on what you could pay out-of-pocket for medical services?

If there are coverage rules that are going to affect what you spend, you’re going to want to make sure you understand everything fully. You’ll be comparing and contrasting Original Medicare vs. Medicare Advantage.

Your coverage

How well does the plan you’re selecting cover the services you need?

With Original Medicare, the plan covers medical services and supplies in hospitals, doctors’ offices, and other health care settings. Services are either covered under Part A or Part B.

[ Learn more about Part A. | Learn more about Part B. ]

When it comes to Medicare Advantage, plans must cover all the same services as Original Medicare. Some plans even offer benefits that Original Medicare doesn’t cover, including vision, hearing or dental.

Any other related coverage

Do you have any other forms of health or prescription drug coverage?

Make sure you understand how those will work with Medicare.

You’ll want to talk to your employment-related benefits administrator or insurer before making any changes to your plan.


Here are some questions you should ask yourself, provided by Medicare.gov:

  • Do you need to join a Medicare prescription drug plan?
  • Do you already have creditable prescription drug coverage?
  • Will you pay a penalty if you join a drug plan later?
  • What’s the plan’s overall star rating?
  • What will your prescription drugs cost under each plan?
  • Are your drugs covered under the plan’s formulary?
  • Are there any coverage rules that apply to your prescriptions?
  • Are you eligible for a free Medication Therapy Management program?

Make sure you know the answers here before jumping into anything new.

Hospital choices and doctors

You’ll want to confirm that your doctors accept your coverage, and if you’d like to start seeing a new doctor or specialist, make sure that person is accepting new patients.

Do you have to choose your hospital and health care providers from a network? Do you need to get referrals? Again, you don’t have to know those answers off the top of your head, but you should look into the issues before selecting or switching plans.

Quality of care

It goes without saying that you should feel comfortable and satisfied with your medical care.

Yet the quality of care and services offered by plans and other health care providers can vary.

You might want to compare plans and providers to see how Medicare and other people with Medicare rated your health and drug plan’s care and services. Here’s a link that can help you do that.

Do you travel?

Original Medicare generally doesn’t cover care outside the country. You may be able to buy supplemental insurance for that purpose. It’s a pretty similar situation with Medicare Advantage. Click or tap here to look into travel coverage.

Simply Healthcare is passionate about making things easier for its members, and offers a variety of Medicare Advantage plans, including many Special Needs Plans.

Medicare Advantage plans include all the benefits of Parts A and B, which cover hospital and medical costs. Most plans also include Medicare Part D for your prescription drug benefits. These plans combine health insurance and drug benefits in one convenient and low-cost plan.

At Simply, the company wants to keep it simple so you can enjoy a healthier life.

Do you have any questions or want to learn more?

Headquartered in Miami with regional offices in Orlando, Tampa, and Sunrise, Simply’s employees are Floridians familiar with the community, physicians, hospitals and plan benefits.

Simply officials say they love being close to their members, which affords them the highest level of service. Phone calls, for example, are answered live by courteous, knowledgeable representatives.

Learn more today.