7 savvy-shopper tips to help you get the most from Medicare

Do you spend your Sunday mornings scouring the newspaper inserts for coupons at the local grocery store? Make it a point to confirm you get all possible discounts when booking hotel reservations? Love getting the senior discount at the movie theater?

If any of these sound familiar, you probably consider yourself a savvy consumer who likes to make sure you’re getting the most value for your money. So, have you ever stopped to consider applying these same skills to Medicare? If not, it may be a good time to start with Medicare annual enrollment right around the corner. Maximizing your Medicare benefits may help you save money and could help improve your health as well.

Here are seven tips to help you maximize the benefits from your Medicare plan.

Medicare covers a number of preventive screenings, such as mammograms and colonoscopies, usually at no additional cost to you. These kinds of services can help catch health problems early when they may be easier to treat. And your annual Medicare Wellness Visit is a good opportunity to sit down with your doctor and develop a plan to help you manage your health in the year ahead.

Many Medicare Advantage plans (Part C) provide extra benefits in addition to services covered under Original Medicare (Parts A & B), such as dental, hearing, and vision coverage. Some plans may bring preventive care right into your living room through in-home care or virtual appointments. These services help offer a simple and convenient way to address minor health concerns.

Medicare costs vary widely based on each person’s situation and coverage selections. Your total health care costs are influenced by: (1) your Medicare premiums; (2) your copay, deductible, and coinsurance rates; and (3) what health services and items you use and how often throughout the year.

Medicare Part B covers 80 percent of the cost for most services that are deemed medical ly necessary, such as doctor visits, lab tests, and other outpatient care. You will be responsible for the other 20 percent, and there’s no limit on out-of-pocket costs. Some people buy a Medicare Supplement insurance plan to help cover some of these costs as well as some costs that come with Part A (hospital insurance).

Medicare Advantage plans generally have set copays for most medical and hospital services, and plans must put a cap on your annual out-of-pocket costs. Once the limit is reached, the plan covers 100 percent of all additional costs for covered services for the rest of the plan year. Medicare sets the maximum out-of-pocket limit options for plans. The highest limit in 2025 is $9,350. 

An annual out-of-pocket cap on health care costs may mean extra peace of mind if you have an unexpected illness or if you’re planning to schedule a medical procedure such as a knee replacement. 

Many prescription drugs are not covered by Original Medicare (Parts A & B), so you may want to get prescription drug (Part D) coverage through a private insurer to help with prescription drug costs and avoid paying a Part D late penalty if you decide to enroll later. There are two options to enroll in prescription drug coverage: you can choose a Medicare Advantage plan that includes drug coverage, or buy a standalone prescription drug (Part D) plan. Either way, savvy shoppers may save money by using plan benefits wisely.

Some plans have a home delivery pharmacy benefit that may help save money and reduce trips to the pharmacy. For example, you may be able to order a 3-month supply of a medication for a lower cost than you would pay if you got the same supply at a local retail pharmacy — and have it delivered to you!

If you prefer to pick up your drugs at a retail pharmacy, check to see if your plan has a preferred pharmacy network. Plan members usually pay lower copays for their drugs when they use a pharmacy that’s part of the preferred network versus one that’s not.

Another potential cost-saving measure is to use generic or other low-cost drugs. Review your current medications with your doctor and ask if there are other options on your plan’s formulary (your plan’s list of covered drugs) that could work for you and help save you money.

Medicare Advantage plans typically work with a network of providers, including doctors and hospitals. Plans contract with network providers to provide care to plan members at negotiated prices. This allows for lower out-of-pocket costs for plan members. Some Medicare Advantage plans offer out-of-network coverage, but the members typically pay more for these services compared to network providers.

Some Medicare Advantage plans offer discounts on things you already use or need, such as vitamins, hearing aids, fitness programs, and alternative medicine services such as acupuncture. Hearing aid benefits may significantly reduce costs, potentially saving you thousands of dollars a year. And saving money on your daily vitamins and a membership to your local fitness center could provide extra motivation you need to stick to a healthy lifestyle.

If you’re turning 65 soon, or are helping a loved one with the Medicare enrollment process, it’s important to enroll in Medicare on time to avoid paying late enrollment penalties. Your first chance to enroll is typically during your Initial Enrollment Period (IEP).. 

If you happen to miss your IEP and do not qualify for a Special Enrollment Period (SEP), you may be subject to Medicare late-enrollment penalties. These extra costs may affect how much you pay for a monthly premium and usually increase the longer you wait to enroll in Medicare. 

A little planning may help prepare you to make timely, educated decisions when enrolling in Medicare for the first time, which could in turn help you avoid unexpected monthly and annual health care costs.

If you’re calculating your short and long-term health care costs, it’s important to understand how recent changes to the Medicare program may help you save on a number of expenses. The Inflation Reduction Act (or IRA) has introduced several changes, eliminating the Medicare Part D “donut hole” and lowering the out-of-pocket maximum. 

By staying informed about Medicare , you may be able to create a more accurate estimate of your potential costs and reduce budget-related uncertainties.

By following these tips, you can help get the most out of your Medicare plan, potentially saving money and supporting a healthier lifestyle