Choosing a Medicare plan that makes sense for you is an opportunity to stay your healthiest — all it takes are a few simple questions.
Whether you choose Original Medicare or enroll in a Medicare Advantage plan, some levels of coverage will be similar. A Medicare Advantage plan may offer added benefits, such as vision and dental, and can also provide the financial security of a yearly out-of-pocket limit on what you pay for covered services in a plan year.
Here are some questions to ask when choosing a Medicare plan:
How much coverage do I want?
If you’re looking for basic coverage, Original Medicare may be enough. It offers a combination of hospital and medical insurance (Parts A and B). To get help paying for prescriptions, you’ll also need a stand-alone prescription drug plan (Part D).
Medicare Advantage (Part C) plans include basic coverage and may include extras, such as fitness benefits and dental, vision and hearing care, that aren’t offered by Original Medicare. Most Medicare Advantage plans also include prescription coverage.
Does this plan fit my finances?
A good way to know how much you’ll actually pay for a plan is to look closely at premiums, deductibles, copays and any yearly limits on out-of-pocket costs. Under Original Medicare, you’ll need to reach a deductible each year before your plan begins to pay. You’ll usually pay 20 percent of the total cost of each service, including primary care doctor visits, and there’s no limit to how much you’ll pay out of pocket each year. Medicare Advantage plans tend to provide more predictable costs and a fixed yearly out-of-pocket maximum.
Will this plan cover my prescription drugs?
Each health plan that offers prescription drug coverage includes a drug formulary — their list of covered medications. Are the medications you’re currently taking listed on the formulary? How much will you pay for brand-name and generic drugs?
For instance, if you choose a Kaiser Permanente Medicare Advantage HMO plan, there are $0 copays on generic drugs and diabetic supplies1. Plus, you can skip a trip to the pharmacy and enjoy the ease of mail-order prescriptions delivered at no cost.
Are there extra benefits I would use?
Check to see if the plan provides dental, vision and hearing coverage. You may also find fitness and health and wellness programs, as well as transportation, travel, and other benefits. You won’t find these with Original Medicare, but they’re often included as part of Medicare Advantage plans, and they vary by plan.
For example, Kaiser Permanente Medicare Advantage plan members have access to the Silver&Fit® Healthy Aging and Exercise Program,2 which offers fitness memberships or at-home workouts at no additional cost.
Choose a health plan with benefits that support your total health. If you’re 65 or older, you may be eligible for Medicare. The open enrollment period is an opportunity for anyone who is eligible for Medicare to consider if their current health plan meets their needs. Every year, Medicare open enrollment runs from Oct. 15 through Dec. 7. If you’re turning 65 or had another qualifying life event, such as moving, you can enroll during a special enrollment period. Take advantage of these times to ask about coverage details and compare plans to meet your health needs.
There is a lot to consider. To learn more about Medicare, you can attend a Kaiser Permanente seminar in person or online, call a Kaiser Permanente Medicare specialist at
You must reside in the Kaiser Permanente Medicare health plan service area in which you enroll. Kaiser Permanente is an HMO plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.
1 Benefits vary by plan. Limitations and restrictions may apply. See plan details at kp.org/wa/medicare.
2 Silver&Fit is a federally registered trademark of American Specialty Health, Inc. New member initiation fees may apply for some premium fitness locations. You must be a Kaiser Permanente Medicare health plan member to remain eligible for the Silver&Fit benefit.
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