How to pick a Medicare plan. And why a 5-star rating matters.

Make an informed decision about your Medicare coverage: Some things to consider during the Medicare annual open enrollment period

Choosing the right health insurance is a big decision we all face to make sure we have the right coverage. It can feel especially daunting if you are 65 or over and enrolling in Medicare for the first time.

What is Medicare?

When you turn 65 (or are ready to retire), you are able to sign up for Medicare, which is basic health insurance provided by the Federal Government. When Medicare was first signed into law in 1965, it fulfilled a promise envisioned by President Kennedy: health care for hardworking Americans in their retirement.

But Medicare only covers about 80% of your medical services, with no additional benefits like vision or hearing exams and dental coverage. So it’s important to shop around and find the right Medicare plan that fits your health, your needs and your life. Here are some important factors to consider.

How to choose a Medicare plan

Check the plan’s overall Medicare star rating. Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates health plans across the country for quality and performance. Plans are rated in many areas—including keeping members healthy, managing chronic conditions, member satisfaction, customer service, pharmacy service, and access to care—and are given a rating of 1 to 5 stars depending on how well they score in each category. Choosing a 5-star plan—the highest rating possible—ensures you get a plan nationally recognized for providing quality health coverage.

For 2019, Tufts Medicare Preferred HMO Medicare Advantage and Senior Care Options plans earned 5 stars for the fourth straight year. In Massachusetts, Tufts Health Plan is the only 5-star plan. Only 14 plans in the country earned a 5-star rating for 2019.

Check the plan’s network. Research says the most important relationship in your health care is your primary care doctor. Make sure she/he is in the network.

How do you view your finances? Do you prefer higher premiums and lower copays for financial predictability? Or perhaps you prefer a lower premium and higher copays to maximize your monthly cash flow. Think about which approach makes you feel more comfortable.

Compare out-of-pocket costs. All Medicare Advantage Plans limit the amount you will pay out of your own pocket for medical services in a year. It’s important to check the out-of-pocket maximum amount for any plan you are considering, as the amount may be different from plan to plan.

Make a list of your prescription medications. Check to make sure they’re covered by the plan you choose. Specifically, compare the copays on your prescriptions, as they can vary from plan to plan.

Compare each plan’s additional benefits. Medicare plans can offer additional benefits and savings for services such as dental, vision, eyewear, acupuncture, hearing aids, nutritional counseling, chiropractic care, yoga, and fitness memberships. Look for a plan with benefits that complement your lifestyle and personal needs.

Now is the time you can choose a Medicare plan

The annual open enrollment period—from October 15 to December 7—gives you the opportunity to choose a Medicare plan that meets your needs. Your health is important—and so is your health care coverage. So take the time to identify your priorities and understand all your options as you decide on a Medicare plan best tailored for your needs.

For more information about Tufts Health Plan’s Medicare Plans go to
Tufts Health Plan is an HMO plan with a Medicare contract. Enrollment in Tufts Health Plan depends on contract renewal. This information is not a complete description of benefits. Call 1-800-488-0229 (TTY: 711) for more information. Every year, Medicare evaluates plans based on a 5-star rating system. Tufts Medicare Preferred HMO plans received 5 out of 5 stars for contract years 2016, 2017, 2018, and 2019. For more information on plan ratings, go to

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