Why You and Your Spouse Might Need Different Medicare Plans
Published by: Medicare Made Clear
It’s not unusual for spouses to be covered under the same health plan for much of their married life—often an employer plan. This can be a wise and economical choice for many couples and families.
All that changes once you’re on Medicare. Medicare is not a family health plan. It is individual insurance, and you have a lot of options when it comes to choosing what kind of coverage you get.
Old habits die hard though, and you could be missing out if you and your spouse simply sign up for the same Medicare Part D or Medicare Advantage plan.
Spouses Need to Consider Their Own Health Care Needs First
Each eligible individual needs to decide what type of Medicare coverage and which specific plan may fit with his or her health care needs. Nobody’s health is the same, and what benefits you want covered under Medicare can impact what kind of coverage you need.
These are the eight things you and your spouse should each consider:
What health conditions you have.
Do you have a heart condition or diabetes? Are you in remission from cancer and need frequent screenings? Consider what your health is like and what services or health items you may need, then look at how Medicare’s different parts cover them.
Which doctors and specialists you see.
Different types of Medicare coverage have different rules. For example, with Original Medicare (only Part A and Part B) you can use any doctor or provider that accepts Medicare. But with private plans such as a Medicare Advantage plan or Part D plan, you may have a specific network of providers and pharmacies you can use without added cost.
What medications you take and how many.
Costs can add up with prescription drugs if you don’t choose a plan wisely. In this case, you only really have two options too – (1) a stand-alone Part D plan or (2) a Medicare Advantage plan. The biggest thing though is that both plans have drug list (formularies), often organized into hierarchical tiers. Costs often increase as the tier levels get higher.
Depending on how many prescriptions you take, how frequently and whether they’re brand-name or generic, your costs could quickly add up. Look carefully at what a plan covers, how much it costs, where you can get your drugs and how, and if the plan provides any financial help like prescription discount cards or reduced rates for 90-day orders.
How often you go to the doctor or other health care professional?
Medicare plans include premiums, deductibles, copays and coinsurance. Consider how frequently you have doctor visits and estimate what you could be paying out-of-pocket. Some Medicare coverage options, like Medicare Advantage plans, come with financial protection.
Do you want a fitness benefit such as a gym membership?
Original Medicare (Parts A & B) doesn’t cover gym membership or other fitness benefits. Medicare Advantage plans can so consider if this is something you may want.
Do you need coverage for dental, vision or hearing care?
Dental, vision and hearing health services and items are not covered by Original Medicare either. These are items you can only get with a Medicare Advantage plan or by paying extra to purchase a separate plan for one or all of these benefits from a private insurance company.
What other medical or prescription drug coverage you may have, such as retiree coverage, TRICARE or VA benefits.
If you have other health insurance, such as with the VA or a group retiree plan, what parts of Medicare you need may vary. Look carefully at how Medicare and your other coverage may work together to give you to meet your health and financial needs.
How would you like your health care coverage organized?
For some people, having their Medicare coverage all in a single plan is extremely helpful. In this case, Medicare Advantage plans are a good choice since they combine all your coverage needs in one place with one company. Others don’t mind having Original Medicare from the government and a Medicare Part D plan from a private company, and paying costs for each separately.
Finding the Medicare Plan That Fits Right
It’s important to find the Medicare plan that’s right for you. You can find plans in your area here by typing in your zip code. You and your spouse may each choose plans you’re interested in. Then each of you may want to compare your plan options side by side to find which one is best for each of you.