Medicare, but make it easy.

Choosing how to set up your Medicare program is a daunting task. Medicare benefits differ widely depending on your plan type. A simple pro-and-con list only gets you so far. That’s because your needs are unique, and your plan options are wide. That’s why we designed this Medicare Suitability Quiz.

Just go through the questions and record your answers. At the end, you should have at least an idea of which plan options fit your unique needs best. From there, you can search for plans available in your area using the Insurify Medicare comparison tool.

Still have questions? Just speak to one of our helpful agents for unbiased guidance. Give us a call at  1-844-965-1378 (TTY 711) Monday-Friday 8am – 8pm ET.

 

 

Medicare Suitability Quiz

Below is a short, two-part quiz to help you decide which Medicare plan(s) are right for you. Simply record your answers on a sheet of paper. Scoring is very simple. Part 1 covers Medicare basics. 

Part 2 helps you uncover if a special needs plan is suitable. SNPs are great for helping people with certain healthcare needs get even more affordable coverage. Don’t skip it!

Part 1

    • Do you want to keep your current doctor AND does your doctor accept Medicare?
      • Yes
      • No 
    • Do you want to keep your current doctor AND does your doctor not accept Medicare?
      • No
      • Yes 
    • Do you spend more than three months in another state?
      • Yes
      • No
    • Do you spend more than two weeks out of the country?
      • No
      • Yes
    • Do you prefer an all-in-one premium payment?
      • No
      • Yes
    • Do you prefer paying a la carte (multiple premium payments)?
      • No
      • Yes
    • Do you want your plan to cover dental, vision, and/or hearing, OR are you comfortable purchasing additional coverage a la carte?
      • A la carte
      • One-stop shop
    • Are you comfortable getting a referral to see a specialist?
      • Yes
      • No
    • Are you planning to relocate?
      • Yes
      • No

Mostly A’s

Congratulations: Original Medicare is the right choice for you. For most Medicare beneficiaries with Original Medicare, adding a Medigap plan is an important step in setting up your healthcare. Be sure to check out our guide to Medigap plans and to compare Medigap plans before you buy. 

Original Medicare is a great choice because:

    • It goes wherever you go (in the United States). If you spend more than a few months a year out of state, your Original Medicare protects you in the event of any medical need. 
    • You won’t need a referral to see a specialist. Just be sure that you’re seeing them for a covered service. 
    • It’s a great option for people who don’t mind paying premiums a la carte. If you decide you don’t like your dental plan, for example, you can make changes to that part of your coverage without changing anything else. That means you’ll have even more control of your plan!

Mostly B’s

Congratulations: Medicare Advantage is a great choice for you. That’s because:

    • Medicare Advantage plans travel with you when you go out of the country.
    • You don’t mind getting a referral. In fact, you prefer to work with a primary care doctor (PCP) to help you manage your care. While Preferred Provider Organizations (PPO) Medicare plans won’t require you to get a referral, most do. That’s because the majority of Medicare plans (and the least expensive plans) are organized as Health Maintenance Organizations (HMO).
    • Medicare Advantage plans can offer you all-inclusive coverage. That means dental, vision, hearing, and prescription drug coverage are included in many plans. 

Do keep in mind that not all Medicare Advantage plans are created equal. And a low monthly premium doesn’t necessarily mean the plan is inexpensive. Read our article all about Medicare Advantage plan costs to learn more about what to expect. 

Part 2: Special Needs Plan Suitability

A special needs plan is a specially designed Medicare Advantage plan. It helps people with certain health conditions get quality healthcare at a low rate. It’s also useful for people with low income. 

    • Do you qualify for Medicaid?
      • Yes
      • No
    • Do you have any of the following chronic conditions?
          • Chronic heart failure
          • Dementia
          • Diabetes mellitus
          • End-stage liver disease
          • HIV/AIDS
          • End-stage renal disease (ESRD) requiring dialysis
          • Chronic alcohol and other drug dependence
          • Autoimmune disorders including polyarteritis nodosa, polymyalgia rheumatica, polymyositis, rheumatoid arthritis, or systemic lupus erythematosus.
          • Cancer, excluding pre-cancer conditions or in-situ status
          • Cardiovascular disorders including cardiac arrhythmias, coronary artery disease, peripheral vascular disease, or chronic venous thromboembolic disorder.
          • Severe hematologic disorders including aplastic anemia, hemophilia, immune thrombocytopenic purpura, myelodysplastic syndrome, or sickle-cell disease (excluding sickle-cell trait).
          • Chronic lung disorders including asthma, chronic bronchitis, emphysema, pulmonary fibrosis, or pulmonary hypertension.
          • Chronic and disabling mental health conditions including bipolar disorders, major depressive disorders, paranoid disorder, schizophrenia, or schizoaffective disorder.
          • Neurologic disorders including amyotrophic lateral sclerosis (ALS), epilepsy, extensive paralysis (i.e., hemiplegia, quadriplegia, paraplegia, monoplegia), Huntington’s disease, multiple sclerosis, Parkinson’s disease, polyneuropathy, spinal stenosis, or stroke-related neurologic deficit.
          • Stroke
      • Yes
      • No
    • Do you currently live in an institution such as a long-term care facility (LTC), skilled nursing facility (SNF), a long-term care nursing facility (NF), an intermediate care facility for individuals with intellectual disabilities (ICF/IDD), or an inpatient psychiatric facility— AND have you lived there for at least 90 consecutive days?
      • Yes
      • No

Any A’s

Yay! An SNP is available to you (so long as they’re offered in your area). If you use Medicaid, you want to look for a D-SNP— a Dual-eligible Special Needs Plan. If you have a chronic condition, you want to look for a “C-SNP.” And if you live in an institution, you should look for an I-SNP.

Both B’s

You likely do not qualify for a special needs plan. 

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Additional Information

What Is Original Medicare?

Original Medicare is a federal health insurance program designed for people over 65 and for people with certain health conditions. Commonly known as Medicare Part A and Part B, it covers basic inpatient and outpatient care. 

Though it is inexpensive month to month, Original Medicare doesn’t pay for everything. It only pays for 80 percent of covered care. And it does not cover:

    • Dental 
    • Vision
    • Hearing
    • Prescriptions

To get additional coverage benefits, you’ll need to purchase stand-alone coverage. While not necessarily a bad thing, it does mean that you won’t have a one-stop-shop for your healthcare needs. You’ll need to find an appropriate Medicare Part D plan (a.k.a. Medicare prescription drug coverage). 

What Is Medicare Supplement Insurance?

Due to the coverage gaps of Original Medicare, you can purchase a Medicare Supplement Insurance plan. Better known as Medigap, this plan offers supplemental coverage for some costs of Original Medicare, such as:

    • Deductibles
    • Coinsurance
    • Co-pays

Medigap plans are regulated by the federal government through the Centers for Medicare & Medicaid Services. But these plans are fulfilled by private insurance companies. Each insurance company receives a contract with the CMS in order to offer plans. 

There are several types of Medigap plans, designated by letters. Each plan offers different coverage levels. For the most part, the more expensive plans offer better coverage for care received. 

However, that’s only a guideline, not a rule. You should also know that every plan of one type is virtually identical to any other plan of the same type. For example, Medigap Plan N from Company X is identical in coverage to Medigap Plan N from Company Z.

Despite the similarities, plans from different companies often have different pricing. That’s because each company has its own business structure that can affect the price it offers customers. Always be sure to compare Medigap plans before you buy. 

What Is a Medicare Advantage Plan?

Medicare Part C, better known as Medicare Advantage, is an alternative to Original Medicare. Though Medicare Advantage becomes your primary coverage, you will still need to pay the Part B premium (and Part A premium if applicable). Like Medigap, Medicare Advantage plans are fulfilled by private insurance companies

MA plans must offer at least the same level of coverage as Original Medicare. But most plans offer extra benefits like:

    • Dental care
    • Vision
    • Hearing
    • Prescriptions

But not all plans do. In fact, besides the basic coverage, each Medicare Advantage plan will differ from insurer to insurer. And remember that you can still opt to purchase a stand-alone prescription drug plan if your Medicare Advantage plan doesn’t offer prescription coverage. 

Be sure to examine each plan carefully when making your decision. You’ll want to note:

    • Monthly premium
    • Annual deductible
    • Co-payment rates
    • Out-of-pocket maximum limits

That last one is very important! An out-of-pocket limit puts a cap on medical costs. Given that medical bills are a common cause for bankruptcy, getting a plan with an advantageous cap on medical expenses can save you big time. 

Finally, most Medicare Advantage plans are structured as health maintenance organizations (HMOs). HMOs help keep costs low, but you’ll need to work within a specific network for care. You’ll also need to work closely with a primary care physician, even when you want to see a specialist. 

You may also find a Medicare Advantage plan in PPO form—preferred provider organization. With a PPO, it’s easier to see out-of-network providers. But PPOs tend to be more expensive. 

Can I Use Medicare Advantage with Medicare Supplement Plans?

You cannot. Medicare Supplement plans are meant to be used with Original Medicare. Medicare Advantage is meant to replace Original Medicare as your primary coverage. 

 

 

FAQ: Original Medicare vs Medicare Advantage

Is Medicare Advantage better than Original Medicare?

Not necessarily. For some beneficiaries, Medicare Advantage (Medicare Part C) will be a better fit than Original Medicare (Medicare Parts A and B). However, Original Medicare—plus a Medigap policy—is a great fit for many. The best plan really depends on the person using it. 

Be sure to consider your unique needs and preferences when deciding on the right plan for you. What works for your neighbor or your sister might not work best for you. 

Are Medicare Advantage plans bad?

Medicare Advantage plans aren’t bad, though some plans are certainly better than others. The real question is: which plan option is better for you? If you travel out of state a lot or you just want to have a lot of control over your healthcare, a Medicare Advantage plan isn’t a good choice. 

But just because a Medicare Advantage plan isn’t good for you doesn’t make the plan option bad overall. 

What are the advantages and disadvantages of Medicare Advantage plans?

Medicare Advantage plans offer you:

  • Comprehensive Medicare coverage with just one premium payment
  • Out-of-pocket cost limits to keep costs under control
  • Additional coverage benefits, like gym membership discounts and wellness programs
Disadvantages of Medicare Advantage include:
  • Preauthorization required for most medical procedures
  • Referrals required to see a specialist
  • Limited service area to in-network providers

The only exception to that last bullet is when you’re seeking emergency care. Generally, emergency room visits will be covered by Medicare Advantage plans wherever you are. 

Is Medicare Supplement or Medicare Advantage better?

Again, that truly depends on your healthcare needs. Both plans offer you a ton of advantages and a few drawbacks. With either plan, you’ll still need to cover your Medicare Part B premium (and Part A’s if applicable). But no Medicare option is one-size-fits-all. You should consider your specific needs and preferences when deciding on the right plan for you. 

Conclusion

Choosing your health plan isn’t always easy. But hopefully, this quiz and additional information have given you a great foundation to help you choose with confidence. Additional information can always be found on the Medicare.gov website. 

And don’t forget that the Insurify Medicare comparison tool is always ready to help you compare plans. You can even compare options side by side to get a clear picture of which plan makes the most sense. Happy shopping!

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Updated April 13, 2021

J.J. Starr is a health and finance copywriter who enjoys helping readers find the information they need. In addition to her background in banking and financial advising, she is also a poet with an MFA from New York University. She lives in Amherst, Massachusetts. You can learn more at jjstarrwrites.com.