Decision: What's the Right Coverage for You?

WebMD Medical Reference

This information will help you decide what Medicare coverage suits your health care needs best.

Key Points in Making Your Decision

There are many choices for health coverage in the Medicare system. You are eligible for Medicare Part A (hospital care) and Part B (doctor visits) when you turn 65. But you can opt out of Part B if you don't want to keep it. Consider the following when making your decision:

  • If you are covered by other health insurance now (from your employer or a spouse's), there is no penalty if you defer Part B (doctor visits) until you or your spouse retires.
  • If you are not covered by other insurance, and you do not keep Part B, you will pay more if you enroll later on.
  • If you do keep Part B, you can buy extra insurance to cover health care costs that the traditional Medicare plan does not cover. Or you can choose a Medicare Advantage (formerly called Medicare + Choice) plan.

Information to Consider

Your choices for Medicare coverage are:

  • Keep your employer's health plan if you are still working, or
  • Get Part A to cover only hospital costs, or.
  • Enroll in the original Medicare plan (Parts A and B, covering hospital and doctor visits), or
  • Enroll in Medicare Advantage, which are privately run health plans sponsored by Medicare.

Medicare Part D will pay for prescription drugs in 2006. Until then, you may want to consider extra coverage to pay for prescription drugs and services not covered by Medicare. You can buy:

For more information, see What Does Medicare Cover?

Reasons to buy extra insurance Reasons not to buy extra insurance
You may want to consider buying extra insurance if:
  • Your medical needs go beyond what Medicare Parts A and B cover.
  • You expect your health care needs to increase in the future.
  • Your out-of-pocket expenses under traditional Medicare would be too high.
Extra insurance may not be right for you if:
  • You don't need much health care.
  • You can easily afford to pay any out-of-pocket expenses.
  • You absolutely cannot afford to buy extra Medigap insurance.

Making Your Medicare Decision

Print out and use this worksheet to help you make your decision. After completing it, compare it to the criteria above. This should give you a better idea of what kind of Medicare plan suits you best.

Circle the answers that apply to you.

I am working and covered by my employer's health plan. Yes No N/A*
My spouse works and I am covered by his/her health plan. Yes No N/A
The health coverage I have now will end soon. Yes No Unsure
I have high prescription drug costs. Yes No Unsure
I am in the hospital often. Yes No N/A
I need to see doctors often. Yes No N/A
I worry that my health will decline in the future. Yes No Unsure
I can afford to pay for anything not covered by Medicare Parts A and B. Yes No Unsure
I already have high out-of-pocket expenses. Yes No N/A

*N/A = not applicable