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Doctors, cost, and where you get care

Answer in your own words. Each choice writes a question to check. Nothing is ranked, and no plan is picked.

Read: Medicare Advantage or a Supplement?

Cost

What matters about cost?
Could you pay a large hospital bill from savings?

Ask which doctor visits and hospital stays would cost you less, and which bills you would still pay.

Doctors

What matters about doctors?
Have you confirmed those doctors?

Ask which doctors and hospitals the plan includes, and whether a referral is required. Confirm on Medicare.gov, with the plan, and with the doctor’s office.

Day to day

Where do you get care?

Is most of your care close to home, and is emergency care away from home enough?

How do you want a routine visit to work?

Ask which of your routine visits can be a video or phone visit from home, which still have to be at the doctor's office, and what each would cost. Through December 31, 2027, Original Medicare generally covers many of these visits from home. Confirm this year's rule. It can change. See the Medicare telehealth coverage.

Where can lab work and imaging be done?

Ask whether lab work and diagnostic imaging can be done at the doctor's office. If you have to go somewhere else, ask whether a transportation benefit covers that trip, how many one-way trips you get, and which locations are included. See the Plan transportation benefits, the Medicare lab tests or the Medicare imaging tests.

How important are dental, vision, and hearing?

If dental, vision, or hearing benefits are limited, what would you pay for the care you use?

Ask the insurance carriers to check your prescriptions at nearby pharmacies of your choice.

Conditions

Do you need to check a plan that is only for people with a certain health condition?

Ask the plan whether it is limited to people with a certain health condition. See the Special Needs Plans.

Plan types to verify

Your answers do not put these in order. Check each kind of coverage on its own. This is not a score, and it does not pick a plan.

  • Original Medicare only

    Parts A and B have no yearly out-of-pocket limit. Prescription drugs need a separate Part D plan.

  • Original Medicare + Medigap

    Medigap adds a monthly premium on top of Part B. A separate Part D plan is still needed.

  • Medicare Advantage HMO

    An HMO uses a network and a service area. Ask whether a specialist visit needs a referral.

  • Medicare Advantage PPO or HMO-POS

    Ask what you would pay for an out-of-network visit, and whether a referral is required.

Suggested actions

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This lists questions for each plan type. It does not rank them, and it does not name a plan. Verify networks, drugs, this year's costs, and whether you can enroll before you make a change.