Medicare Coverage Recommendation Guide

Start with the customer

Enrollment timing can affect Medigap options.

Age

Medicare Part B effective date

Current coverage

New to MedicareEntering the initial enrollment decision

Medicare AdvantageReviewing or changing an MA plan

MedigapReviewing a supplement policy

Continue to priorities

What matters most?

These answers set the scoring weights. They do not replace checking doctors, drugs and enrollment eligibility.

1. How important is keeping the monthly premium low?

Very importantI prefer lower fixed monthly cost.

BalancedI will pay more for stronger protection.

Not importantPredictability and access matter more.

2. How important is keeping current doctors and hospitals?

EssentialAll key providers must be confirmed.

PreferredSome provider changes are acceptable.

FlexibleI am comfortable using a plan network.

3. How often is routine care needed away from home?

OftenSnowbird, frequent travel or two residences.

SometimesSeveral trips each year.

RarelyMost care is local.

4. How comfortable is the customer with a high annual medical maximum?

Not comfortablePrefer predictable costs.

ModeratelyCan absorb some variable cost.

ComfortableCan handle a higher MOOP for lower premiums.

5. What level of network restriction is acceptable?

Open accessNo referrals and broad provider choice preferred.

PPO acceptableSome out-of-network flexibility matters.

HMO acceptableNetwork rules are acceptable for savings.

6. How important is integrated prescription coverage?

Very importantPrefer medical and Part D together.

NeutralEither bundled or separate is fine.

Not importantComfortable selecting a separate Part D plan.

7. How valuable are dental, vision, hearing and fitness extras?

Very valuableExtras materially affect the choice.

Nice to haveConsider after medical fit.

Low priorityCore medical coverage comes first.

8. How important is avoiding office and hospital copays?

Very importantPrefer minimal point-of-service bills.

BalancedModerate copays are acceptable.

Low priorityCopays are acceptable for a lower premium.

9. How important is long-term coverage continuity?

Very importantPrefer less annual plan and network change.

BalancedWill review coverage each year.

Low priorityComfortable shopping annually.

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Coverage recommendation

Based on the customer’s stated priorities

Medicare Advantage fit0

Original Medicare + Medigap fit0

Back to priorities