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Words of wisdom: 5 proven tips for researching Medicare benefits

Christina Joseph By Christina Joseph

When Susan Cirullo was getting ready to retire 13 years ago, she had a clear picture of how she’d spend her golden years: traveling, golfing and, hopefully, doting on future grandchildren. Staying active would be an essential part of a dream retirement for the former health and physical education teacher. So would choosing the right health plan.

Susan retired several years before qualifying for Medicare. In the interim, she was covered by a retiree group plan that allowed her to “test-drive” benefits. When she became eligible for Medicare, she already knew what she wanted out of a plan. Still, she did her fair share of research before making a choice and feels that’s a big reason she remains so satisfied with her coverage. Susan has been an Aetna member since 2014.

Given Susan’s great track record, we asked if she had any tips to help the newly eligible as they research Medicare benefits. Read on to learn the secrets of her success.

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Susan baking with her granddaughters.

1.     Know yourself

A resident of Pennington, New Jersey, Susan knew her retirement agenda would include lots of travel. “We had a second home in Maine when I retired,” she explains. “I wanted to make sure that whatever insurance I chose covered me in both places.” With some Medicare plans, in-network doctors aren’t accessible outside your home state. But thanks to Susan’s foresight, she was recently able to join some school friends for a fly fishing outing in Montana without worrying about coverage.

Some lifestyle choices influence the type of benefits you need. Before you begin researching coverage, make a list of your goals for retirement. This will give you a sense of which plans check all or most of your boxes. Some questions to ask yourself include:

  • Hope to travel? If you have family or a vacation home in another state, you may want to look into coverage options in that area. If overseas travel appeals to you, ask about emergency healthcare abroad.
  • Are you a gym-goer? Gym memberships are available through certain plans.
  • Take maintenance medication? Some plans offer prescription drug coverage, but not all. You may need to buy a separate plan.
  • See a variety of doctors? You may want coverage for out-of-network providers in case of unexpected health problems.
  • Have a chronic condition? Some plans offer special programs for chronic disease management.

Susan isn’t planning on slowing down anytime soon. “I’ve been blessed with good health, and I want to keep it that way,” she says.

Learn how to make Medicare enrollment easier on yourself.

Go deeper on the questions to ask before choosing a Medicare plan.

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Susan and her daughter strolling through her New Jersey neighborhood.

2.     Know the benefits you can choose from

Susan walks daily and plays golf regularly. She wanted a plan that would support her active lifestyle and promote preventive care. That meant getting familiar with the variety of available benefits. Susan recommends researching the basics first — doctor visits, hospitalization and drug coverage. Then look for convenient perks, such as nutrition counseling or a 24-hour nurse helpline.

Get comfortable with Medicare’s alphabet soup of coverage — Parts A, B, C and D. Understand that different parts cover hospital stays (Part A), doctor visits (Part B) and medications (Part D; more on this one in the next section). Know that some plans, like Medicare Advantage (also called Part C), cover extras such as dental, vision, hearing and gym memberships. Keep a cheat sheet nearby if you have trouble remembering which is which.

Learn what you need to know about the ABCs of Medicare.

Your cheat sheet to the different parts of Medicare.

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3.     Consider prescription drug benefits (even if you don’t need them now)

Susan currently takes just one prescription medication, but she knows that could change. So she picked a plan with prescription drug coverage. A 2019 AARP survey found that 80% of respondents over 50 take prescription medication on a regular basis, and 72% said they were concerned about the cost of their medications.

While most employer-based health insurance plans include prescription drug benefits, Medicare is different. When you sign up for Original Medicare, you’ll need to purchase a separate drug plan. Most Medicare Advantage plans, on the other hand, include prescription benefits.

Susan cautions against opting out of a prescription drug plan. Even if you’re not taking any medication now, the future is hard to predict. What’s more, opting out of drug coverage when you first join Medicare can mean penalties if you sign up later on.

Learn about prescription drug coverage.

Read more about how to avoid penalties.

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4.     Know how much you can afford to spend on health care

A former state employee, Susan receives a pension. She can afford to pay a little more for a plan with a lower cap on annual out-of-pocket expenses. This will protect her finances if she later develops a serious (and expensive) medical condition.

Budgeting for health care is an important part of retirement planning. Keep in mind that some plans may cost more upfront, but offer benefits that can save you money over time. When researching Medicare plans, be sure to consider the following:

  • The premiums you’ll be paying for the different parts of Medicare.
  • The cost of regular prescription medications and doctor visits.
  • Plan deductibles and out-of-pocket maximums.

If the mere mention of “deductibles” and “out-of-pocket maximums” makes you anxious, it might be time to brush up on your insurance terminology. A deductible is the amount you must pay for covered health services or prescriptions before your insurance plan begins to pay. An out-of-pocket maximum is the most you’ll pay during a policy period (usually a year) for covered health services. Once you reach your maximum, your plan pays 100% on covered health services. Learning the lingo will help you make informed choices about the plan that best meets your health need and budgets.

Read up on the most commonly misunderstood Medicare terms.

5.     Consider whether it’s important to keep your current doctors

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Susan teaches the grandkids how to fly-fish.

When she retired, Susan had been seeing the same doctors for years. They knew her history, and she felt comfortable in their care. She didn’t want to lose those relationships in the event they were no longer in-network. So Susan made sure she had access to her same doctors under her new Medicare plan.

Susan admits she wasn’t always able to vet her benefits so carefully. Several years ago, she lost her husband William to cancer. When he was in treatment, Susan didn’t have time to think about anything else. She just wanted to know that she was covered so she could concentrate on taking care of him.

If you find yourself in a similar situation, you might consider a plan that allows you to access out-of-network doctors or hospitals. This will allow you to focus on the things that matter most.

Ultimately, Susan chose a Medicare Advantage plan because it supported all her goals under one plan.  Her initial research continues to pay dividends. Not only is she still healthy and active, she believes her decision to focus on maintaining her health is setting a positive example for her grandchildren. “I have two granddaughters now,” Susan says. “I want them to grow up to be healthier women because they’ve had wonderful role models.”

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Learn more about Medicare Advantage.

Feel like you could use some help researching Medicare plans? An independent insurance agent can help. Writing down some questions in advance can maximize the time you spend with an agent. 

About the author

Christina Joseph Robinson is a veteran editor and writer from New Jersey who still loves to read the old-fashioned newspaper. She’s raising two fruit-and-veggie loving daughters to balance all the treats Grandma sends their way. Christina’s health goal is to resume her workout routine after being sidelined by injuries.