When it comes to Medicare, everyone has different needs.

Fortunately, it’s possible to customize coverage based on your personal circumstances. You’ll need to consider your health care and prescription medication needs, the doctors you would like to see and the plans available in your area.

The following are hypothetical examples of people who are about to turn 65 and are facing a decision about Medicare. Your costs will differ, but their cases can help you pinpoint the best choices for you.

Alicia is retired and has five grandchildren who live in different states. She travels frequently to visit them, often staying for a few weeks at a time. She also travels internationally every few years. She takes three prescription medications and sometimes sees specialists when she’s traveling.

Alicia’s decision: original Medicare.

She’ll have coverage for doctor visits and hospital stays when she visits her grandchildren and won’t be limited to a regional provider network with a Medicare Advantage plan.

Alicia won't need to pay the Part A premium. She worked only 32 quarters because she took time off to raise her children, but her husband had more than the 40 quarters needed to qualify for premium-free Part A before he died. So she's able to receive this benefit based on her husband's work history.  

Alicia buys a supplemental Medigap policy to help cover the costs of deductibles and copayments for Part A hospitalization and the 20 percent coinsurance for Part B doctor visits and outpatient services. The policy she picks provides some coverage for foreign travel. She purchases a Part D prescription drug plan that will cover her medications. Her costs:

• $174.70 monthly premium for Part B in 2024, plus a $240 deductible.
• $123 a month for a Plan G Medigap policy.
• $34.80 a month for a Part D plan, plus a $545 deductible and cost sharing for most medications.

Frank is retired and receiving Social Security benefits. He’s healthy, and other than his annual medical checkups, he doesn’t see a doctor very often or take any medications.

He doesn’t travel much, and he’s looking for the least expensive way to get coverage in case he develops any medical conditions. He wouldn’t mind switching doctors if he can save money by doing so.

Frank’s decision: Medicare Advantage

Since Frank is already receiving Social Security benefits, he’ll be enrolled automatically in parts A and B of Medicare and his Medicare coverage will start the first day of the month he turns 65. He won't need to pay the Part A premium. He chooses a Medicare Advantage plan that doesn’t charge a monthly premium, has no health deductible and has prescription drug coverage. The plan doesn’t cover out-of-network providers and hospitals, but he finds a new doctor nearby. He won't have to pay a copay for preventive care or visits to his primary care doctor. His costs:

• $174.70 monthly premium for Part B in 2024.
• $30 copay for specialist visits, plus copays for other medical services and procedures, such as lab visits, physical therapy, urgent care and X-rays.
• $150 annual deductible before the plan starts paying for any occasional prescription.
• $325 daily copayment for days 1 through 5 as an inpatient in the hospital. No charge for days 6 through 90.
• $5,900 annual out-of-pocket maximum for in-network health services in 2024 for the plan he chose, not including premiums or prescription drug costs. So he won’t be responsible for any charges beyond that amount for services in his plan’s network.

If Frank develops any health problems and needs regular prescription medications — or if he wants to start seeing a doctor who isn’t covered under his current plan — he can reevaluate his Medicare Advantage options or switch to original Medicare during the annual open enrollment period, which runs from Oct. 15 to Dec. 7. A switch to another plan would start Jan. 1. Or he could swap Medicare Advantage plans during the other open enrollment period, which runs from Jan. 1 to March 31. 

Switching to original Medicare after being in a Medicare Advantage plan could be more difficult for him if he also wants to buy a private Medigap policy. If more than six months have passed since Frank enrolled in Part B, Medigap companies could charge him more or reject him for any medical conditions he developed before he decided to switch.

Edgar is working for a large employer and doesn’t plan to retire for several years. He’s happy with his employer’s health plan, which covers dental, medical, prescription and vision costs and has low premiums and deductibles.

Edgar’s decision: Part A of Medicare and his employer’s health plan

Edgar signs up for Part A during his initial enrollment period because it’s free but decides not to sign up for Part B yet because he’s happy with his employer’s plan. Since he works for a company with 20 or more employees, his job-based insurance will be his primary coverage even after he turns 65, and he won’t be required to start paying the Part B premiums. His costs:

• Existing costs for his company’s medical insurance, including deductibles

To avoid a late enrollment penalty, he will need to sign up for Part B before or within eight months of leaving his job and losing coverage as an active employee, unless he's able to switch to the plan of his spouse who is still working. At that point, he’ll also be able to sign up for a Medigap plan and Part D coverage. Or he can choose to enroll in a Medicare Advantage plan.

Max takes two medications and tends to have a lot of dental expenses. He doesn’t travel much and is looking for a plan that covers his medications and dental care. He sees a cardiologist regularly.

Max’s decision: Medicare Advantage

Max signs up for parts A and B of Medicare during his initial enrollment period (he won't need to pay the Part A premium). He chooses a Medicare Advantage plan that covers visits to his dentist and cardiologist. It doesn’t charge a monthly premium, and there's no annual deductible. When comparing plans, he looks at the total cost — premiums plus copays — for his medications and other medical expenses. His costs:

• $174.70 monthly premium for Part B in 2024.
• $45 copay per visit to his cardiologist and other in-network specialists.
• $1,000 annual dental coverage limit.
• $0 copay per visit to an in-network primary care doctor or a $30 copay per visit to an out-of-network primary care doctor.
• Other copays or coinsurance for medical services and procedures, such as lab visits, physical therapy, urgent care and X-rays.
• $5 copay for his generic medication and a $47 copay for the brand-name drug he takes, which is on the plan’s preferred list. Brand-name drugs that aren’t in the preferred pricing tier have a $100 copay.
• $395 a day for days 1 through 5 of a hospital stay. He’ll have no charge for days 6 through 90 at an in-network hospital. However, if Max chooses to go to an out-of-network hospital, he will pay 45 percent of the total cost of the hospital stay.
  
• $5,900 annual out-of-pocket maximum for in-network health-care costs, not including premiums or drug costs. So Max won’t be responsible for any charges beyond that amount for services in the plan’s network ($9,550 for in-network and out-of-network).

Marie retired five years ago after a long career as a teacher, and she’s happy with her retiree health insurance, which includes medical and prescription drug coverage. She can keep her retiree coverage if she continues to pay the monthly premiums.

Marie’s decision: Parts A and B of Medicare, plus retiree health insurance

Since Marie isn’t working, she signs up for parts A and B of Medicare during her initial enrollment period. Medicare will become her primary coverage when she turns 65, and her retiree coverage will become secondary. She won't need to pay the Part A premium because state and local government employees hired after March 31, 1986, have mandatory Medicare coverage. (Many hired before then also started paying Medicare insurance at some point in their careers under a Section 218 agreement between a state and the Social Security Administration.) Her costs:

• $174.70 monthly premium for Part B in 2024.
• Existing costs, including premiums, deductibles and copayments, for her retiree coverage.

Marie won’t need to sign up for Part D as long as her retiree benefits provide drug coverage that's considered at least as good as Medicare’s, known as creditable coverage. She should receive a letter from her retiree plan each September letting her know whether the retiree plan’s drug coverage is considered creditable. She should keep those letters in case she has to buy a Part D plan later and needs to prove that she had coverage to avoid paying a penalty.

Andrew is receiving Social Security benefits and doesn’t have any health problems. He wants coverage from original Medicare because some of the doctors and hospitals he would like to use aren’t included in the Medicare Advantage plans in his area. But he’s not sure he wants to pay extra for a Medigap policy.

Andrew’s decision: original Medicare, including a Medigap policy

Since Andrew already is receiving Social Security benefits, he’ll be enrolled automatically in parts A and B of Medicare, and his Medicare coverage will start the first day of the month he turns 65. He won't need to pay the Part A premium. He decides to buy a Medigap policy to avoid potentially large out-of-pocket costs for hospitalization and outpatient services. 

The policy will cover the Part A deductible, which is $1,632 for each hospital stay per benefit period in 2024, plus copays of $408 a day for days 61 to 90, $816 a day for up to 60 more days and the full cost of up to 365 additional days after Medicare benefits are used up. It also will cover the 20 percent coinsurance for Part B services and other out-of-pocket costs.

In addition, Andrew chooses a Part D policy that covers his medications. His costs:

• $174.70 monthly premium for Part B in 2024.
• $240 annual deductible for Part B.
• $111 a month for a Plan G Medigap policy.
• $40 a month for a Part D policy, and a $545 deductible for most drugs.
• Copayments or coinsurance for any medications.