Most people enroll for Medicare during their Initial Enrollment Period (IEP), which is a seven-month period surrounding their 65th birthday. Doing so opens the door to more affordable healthcare, prevents late enrollment penalties, and ensures uninterrupted coverage.
If your IEP is approaching, now’s the time to partner with an advisor at Exact Medicare. Choosing the right plan involves comparing coverage options, weighing costs, and matching benefits to your personal health needs. Our Medicare help service provides guidance every step of the way, so you’re not left second-guessing your choices.
Step 1: Review Your Medicare Coverage Options
The first step is to learn about the coverage choices available. Medicare offers several paths, and understanding how they differ helps you choose the right one:
- Original Medicare (Parts A and B) is the traditional program managed by the federal government. Part A covers hospital services, while Part B covers outpatient care, including doctor visits and preventive services.
- Medicare Advantage (Part C) is offered by private insurers approved by Medicare. They combine the benefits of Part A and Part B, and many include prescription drug coverage and other additional services.
- Prescription drug coverage (Part D) helps with the cost of medications. Each plan has its own list of covered drugs, called a formulary, and premiums vary widely. A higher premium doesn’t always mean more coverage, so it’s important to check that your prescriptions are included.
- Medigap (supplemental insurance) fills coverage gaps left by Original Medicare, so you have fewer unpredictable out-of-pocket costs. Note that you cannot have both Medigap and Medicare Advantage plans at the same time.
- Medicaid is often confused with Medicare, but these programs are entirely separate. You may qualify for Medicaid at any age if you meet low-income requirements. This can be combined with Medicare to further reduce costs.
If you have any questions about your coverage options, seek Medicare enrollment help from the knowledgeable advisors at Exact Medicare. We’ll explain each option clearly, answer your specific questions, and help you see how the pieces fit together.
Step 2: Consider Your Specific Healthcare Needs
Once you understand the coverage basics, the next step is to review your health and lifestyle. Here’s what we’ll go over with you:
- Doctor visits: If you see your primary care physician often, you may benefit from a plan with low copays for office visits.
- Prescription medications: We’ll check your current prescriptions against each plan’s formulary to ensure they’re covered.
- Specialist care: Frequent specialist appointments can add up. Some plans require referrals, while others allow direct access.
- Hospital services: If you’ve had prior hospitalizations or anticipate needing care, it’s wise to have better inpatient coverage.
- Time spent away from home: If you travel regularly or live part-time in another state, the local or regional networks of Medicare Advantage plans may be too restrictive. International travel is another concern, as Medicare generally doesn’t cover care outside the country. However, some Medigap plans offer limited international coverage for medical emergencies.
Step 3: Understand Costs
Cost is among the most significant factors when choosing a plan. Exact Medicare reviews every detail so you understand what you’ll pay, both monthly and when you need care. Here’s what to plan for:
- Premiums are the monthly amount you pay to maintain coverage.
- Deductibles are what you must pay out of pocket before coverage kicks in. Lower deductibles usually mean higher premiums, and vice versa.
- Copays are flat fees for services such as doctor visits or prescriptions.
- Coinsurance is a percentage of costs you share with your plan after meeting the deductible.
Medicare plan assistance helps you understand how these costs fit together and which structure makes the most sense for your situation. For instance:
- Part A includes hospital costs with a deductible, but most people pay no premium.
- Part B usually requires a monthly premium plus coinsurance for services.
- Part C generally offers lower premiums but higher service costs.
- Part D covers prescriptions with varying premiums and copays.
- Medigap covers copays, coinsurance, and deductibles for a monthly premium.
Step 4: Check Provider Networks
In-network providers typically mean lower costs, while out-of-network providers may result in higher bills or limited coverage. If you already have a doctor or hospital you trust, provide this information to Exact Medicare, and we’ll confirm that your preferred healthcare professionals are covered in-network.
Step 5: Tack on Additional Benefits
Many plans include extra benefits. Think about which of these you find the most useful, and focus on plans that provide coverage you’ll actually use:
- Dental care includes coverage for preventive cleanings, restorative work, and dentures.
- Vision care covers eye exams, glasses, and contact lenses.
- Hearing care lowers the cost of hearing exams and hearing aids.
- Wellness programs may include fitness memberships, nutrition counseling, and preventive health incentives.
Step 6: Pick Your Plan
Once Exact Medicare has reviewed your coverage options, healthcare needs, costs, networks, and extras, it’s time to select a plan. We provide personalized recommendations that align with your priorities. Following this process to enroll in Medicare step by step reduces confusion and leaves you confident that you’ve made a well-informed choice.
Step 7: Review Coverage Annually
Your needs and the plan offerings from Medicare can shift each year. You might qualify for a Special Enrollment Period (SEP) if you move to a new area, lose employer coverage, or become eligible for Medicaid.
Even without a qualifying event, it’s wise to review your coverage once a year during open enrollment from October 15 to December 7. This is your chance to change your plan based on new prescriptions, provider changes, or lifestyle updates. Exact Medicare takes pride in providing transparent Medicare plan assistance during open enrollment, so you can feel secure in your coverage choices year after year.
Why Work with Exact Medicare?
Medicare is complicated, and everyone’s situation is different. Exact Medicare serves retirees across the country with a customer-first approach rooted in honesty and trust. Our Care Team values open communication, delivers personalized guidance, and supports you long after your plan is in place. Get in touch today for help finding coverage that supports your unique health and financial needs.