3 MIN READ | General

James Wallace

How to Determine if Medicare Is Right for You

Cite This
James Wallace, (2020, September 1). How to Determine if Medicare Is Right for You. Psychreg on General. https://www.psychreg.org/medicare-right-for-you/
Reading Time: 3 minutes

Retirement is when everything changes. You may feel excited to have time to catch up on naps, start new hobbies, or finally reach peak fitness, but you don’t want to forget one key consideration, which is health insurance. If you are beginning to plan for retirement, you also need to start thinking about health insurance. 

You probably know that Medicare has become a rite of passage for American seniors, but you might wonder if it is right for you. If you are unsure, take a look at some critical considerations about this benefit available to American seniors after retirement. 

The Medicare eligibility factor 

One of the first things you need to think about when considering Medicare is whether you are eligible. If you are about to retire and are considering Medicare options, you are probably qualified, but it is worth looking at key Medicare eligibility requirements

  • Those turning 65 years of age or older 
  • Citizens or permanent residents of the US
  • People with a disability, even those younger than 65 years old 
  • Those with end-stage renal disease (ESRD)
  • Applicants receiving Social Security benefits
  • Those with Lou Gehrig’s disease 

Original Medicare Plans 

Medicare offers seniors and others eligible for the healthcare system a few different plans. The first part of the system includes Original Medicare, which features Part A and Part B. Learn more about each part: 

  • Part A offers hospital, skilled nursing and hospice coverage. Applicants or spouses with 10 years of Social Security work history will enjoy this part of Medicare for free. Members without work history may pay up to $413 per month. 
  • Part B covers care involving doctor visits, prevention, outpatient treatment and in-hospital care. Part B costs members an average of $134 per month for those with incomes less than $85,000 per year. Members with higher incomes, exceeding $214,000, might pay up to $428.60. 

Medicare Advantage Plans

Medicare Advantage Plans are special types of Medicare health plans available through a private health insurance carrier. Your carrier will provide all your Part A and B benefits while adding more benefits to your plan, such as drug coverage. There is much more to it, so it is crucial for you to take your time in comparing Medicare Advantage plans

  • A Part C Medicare Advantage Plan for HMOs provides most of your care from a network of providers unless it is an emergency. In some cases, you may need a primary care physician referral to see a specialist. This plan is right for you if you are looking for lower costs and don’t mind receiving care from a network of providers. Your providers must participate in the Part C network, and your primary care physician must coordinate all of your care, providing referrals for all tests and specialists. 
  • A Part C Medicare Advantage Plan for PPOs provides a network of doctors and healthcare providers, but you have the freedom to see providers not on that list. You do not need a referral to see a specialist. A PPO plan may be right for you if you don’t mind higher costs than HMO plans as long as you have more freedom of choice and flexibility regarding doctors and seeing specialists and getting tests without a referral. 

Do you think Medicare is right for you? 

The chances are good that you want Medicare upon retirement, but it is more a matter of what type of Medicare you might want. The most vital choices often come down to what you want from your coverage based on your specific needs. Spend time comparing plans in order to do what’s best for you.

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Image credit: Freepik


James Wallace has been an advocate for mental health awareness for years. He holds a master’s degree in counselling from the University of Edinburgh.


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