When transitioning into Medicare, many people want to stay with the same doctors they know and trust. With some plans you can see any doctor who accepts Medicare, and with others you may have limited out-of-network coverage. Be sure to check if your doctors are in-network for the plan you’re considering.
Our prescription drug benefits and covered-drug lists, also known as a formulary, vary by plan. Before choosing a plan, it’s a good idea to see if your medications are listed on the plan’s covered-drug list.
Do you travel to different states to see family? Are you planning a trip abroad? Consider these questions and how often you’ll need to see providers or get prescriptions filled while traveling. In most cases, Original Medicare won’t cover your care while you’re outside the United States, so be sure you understand your options.
Original Medicare does not include routine dental or vision care, or hearing aids—so you may want to consider what level of care you’ll need for your teeth, eyes and ears. You’ll also want to think about care options like 24/7 telehealth, or well-being programs that can help you stay healthy in the years ahead.
Premium: The amount that you pay for your health plan. You usually pay it monthly, quarterly or yearly.
Deductible: The amount you pay for covered health care services before your health plan starts to pay. There may be a medical deductible and/or a separate prescription deductible on your plan.
Copay: A fixed amount ($15, for example) you pay for a covered health care service, usually when you receive the service.
Coinsurance: Your share of the costs of a covered health care service. For most care, you pay any deductibles before coinsurance kicks in. For example, if a doctor’s visit is $100 and you’ve already met your deductible, your coinsurance of 20% would be $20. Regence pays the rest.
Out-of-pocket maximum: The limit to how much you’ll pay out of pocket in a year. Once you hit that maximum, your covered care is paid at 100% for the rest of the year.
Last updated 03/22/2021