By Jill Hup, MD, Family Physician, Summit Health
Starting Oct. 15, almost 20% of Americans will be faced with the task of selecting their 2025 Medicare health insurance benefits as part of Medicare’s Annual Enrollment Period. As plans and coverage have changed this year, it’s more important than ever to have a plan options review with a trusted licensed insurance agent. At Summit Health, we want to connect you with the right resources to make a confident, informed decision about the plan that is right for you today.
In my role as a primary care doctor, I have received many questions over the years from patients regarding what health insurance plan they should choose. While I can’t answer that specific question, I was able to give them some questions they should consider when selecting a plan. Here are the 5 questions I recommend everyone consider when making your Medicare selection.
Q. What kind of medical needs do I anticipate I will have in 2025?
A. Medicare is made up of four parts each providing you with different coverage.
- Part A (hospital insurance)
- Part B (medical insurance)
- Part C (Medicare Advantage)
- Part D (drug coverage)
This is where having a conversation with your primary care doctor and making sure you have a healthcare team in place is so important.
Q. Are my doctors and advanced practice providers* covered by this plan?
A. Original Medicare (Part A/B) allows you to visit any doctor in the United States who accepts Medicare. If you choose a Medicare Advantage plan, you will need to select from a specific network of primary care doctors, specialists and hospitals. However, you may be able to see an out-of-network doctor for covered services, usually for a higher out-of-pocket cost, if the doctor agrees to treat you and accepts Medicare.
The Annual Enrollment Periods helps ensure each Medicare patient is attributed to a doctor or if a specific payer allows it, an advanced practice provider (APP) such as a nurse practitioner or physician assistant. Check with your doctor or APP to make sure they accept Medicare and if they are included in the network of any Medicare plans you are considering.
Q. Does the prescription drug coverage meet my needs?
A. Whether you choose a Medicare Part D or Medicare Advantage plan, it is important to look at the list of drugs it covers and make sure it includes your current medications. If you have any questions about your medications, talk to your primary care doctor, APP or pharmacist.
You will also want to make sure your local pharmacies can fill your prescription and if you can get prescriptions sent to you by mail.
Q. What are my out-of-pocket costs?
A. Out-of-pocket expenses are the costs you are responsible for paying after Medicare has paid their share. This can include your monthly premium, deductibles, coinsurance (the percentage of costs of a covered health care service you pay after meeting your deductible) and copayments.
It is critical to review this information before selecting a plan, especially if you are on a fixed income. Please note that Original Medicare does not have an out-of-pocket maximum while Medicare Advantage plans will vary in out-of-pocket costs.
Q. What other benefits are included?
A. Take the time to review the different benefits available in each plan you are considering. Maybe you want a plan that covers vision or dental exams. Or perhaps it is important for you to have hearing exams or a fitness program as part of the coverage. Whatever it is, make sure to include it in your decision-making process.
This is a wonderful opportunity to review your insurance options and to have a conversation with your primary care doctor or APP about your health and medical expectations for the upcoming year.
For more information on Medicare and what’s best for you…
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