Medicare is a national health insurance program created to alleviate health costs for qualified recipients, but if you’re one of many who do not have sufficient knowledge about its benefits, how would you know which plan to enroll in?
Let’s break down some of the most asked questions about Medicare and find out which plan serves you best.
Who Qualifies For Medicare?
In the United States, Medicare serves as a federal health insurance program for eligible Americans who are:
- 65 years and older
- Diagnosed with end-stage renal disease (ESRD) which requires dialysis or a transplant
- Diagnosed with ALS (Lou Gehrig’s Disease)
Understanding Medicare benefits and how they can serve you in the long run is important. Medicare’s plans have different offerings and seemingly intricate structures that can be intimidating to first-time enrollees, especially if you have never participated or enrolled in a government program before.
If you have the proper knowledge about which Medicare plan to enroll in, you’ll be able to choose the most suitable plan that will help you receive the best medical care according to your needs with health providers you trust.
Your ability to select the right Medicare health coverage plan to enroll in will ultimately save you time and money.
What Should You Consider When Choosing A Medicare Plan?
According to the official U.S. government website for Medicare, there are seven things to consider when choosing a Medicare insurance plan.
- How much you willing to pay for doctor visits, prescription drugs, hospital stays, and other services every year?
- Which type of service or supplies do you need your Medicare plan to cover?
- Other Insurance Coverage
- Do you have secondary coverage or health insurance from another carrier?
- If so, how do they work with Medicare?
- Do you have secondary coverage or health insurance from another carrier?
- Prescription Drugs
- Do you take formulary medicine that will not be covered by the Medicare plan?
- Do you already have existing prescription drug coverage from another carrier that will pay for your medicine?
- Will you be eligible to participate in the free Medication Therapy Management (MTM) program?
- Doctors and Hospitals
- Have you asked your existing medical providers if they will accept the Medicare plan?
- Will the providers and facilities in the Medicare plan’s network be willing to accept you as a new patient?
- Will the providers need a referral to accommodate you as a patient?
- Quality of Care
- Have you checked the reviews and feedback from existing members?
- Would you be satisfied with the level of care the plan’s participating providers provide?
- Would you need coverage when you’re outside the U.S.?
What Are The Different Parts Of Medicare?
There are four parts of Medicare health insurance to choose from: Part A, Part B, Part C, and Part D.
- Part A and Part B – The first two parts of Medicare, Part A and Part B, are known as Original Medicare and are a part of a federal health insurance program run by the government.
- Medicare Part C (Medicare Advantage) and Part D (prescription drug coverage), on the other hand, are largely offered by private companies that are contracted with Medicare.
Each plan covers specific benefits and services, such as doctor’s visits, facility confinement, and prescription drugs.
In addition to the four parts of Medicare, supplemental insurance policies, known as Medicare Supplement or Medigap policies, are available as an option for individuals seeking to cover certain health care costs. Medigap policies help to cover costs not paid for under Original Medicare as well as certain out-of-pocket expenses, such as deductibles, coinsurance, and copayments.
Since Medicare began in 1965, the program only offered two plans (Parts A and B). These plans are run by the federal government. You are automatically enrolled in these plans when you turn 65 and receive Social Security or Railroad Retirement Board (RRB) benefits or if you meet other automatic enrollment qualifications.
As for premiums, you will be required to pay premiums for these plans once you’ve enrolled but you don’t have to pay a premium for Part A if you have enough work credits earned from your or your spouse’s employer.
Medicare Part A
Part A primarily takes care of your inpatient hospital stay. It also covers your confinement in a hospice or in skilled nursing facilities. If you need home health care, this plan covers certain types of services that qualify for payment.
Medicare Part B
Part B takes care of your doctor’s visits including services rendered at the doctor’s office. If you have to stay in a hospital or a medical facility for an outpatient procedure, this plan will give you coverage.
Preventive services, including wellness check-ups and immunizations that are prescribed by your physician to treat your condition, will be covered under this plan.
Qualified medical supplies like Durable Medical Equipment (DME) are also covered. DME includes blood sugar monitors, nebulizers, crutches, wheelchairs, and hospital beds.
Part B also covers ambulance services if they’re a medical necessity as well as mental health-related services. In some instances, certain outpatient prescription drugs will be covered as well.
Medicare Part C (Medicare Advantage)
Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare. Medicare Advantage offers Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) coverage from accredited private health insurance companies.
Medicare Advantage covers the same benefits under the Original Medicare umbrella except for hospice care. But it goes a level more by offering additional benefits not covered by Parts A and B including hearing and vision benefits as well as preventive dental care.
Some Part C plans include prescription drug coverage (Part D) as part of their bundled package.
Unlike Original Medicare which normally charges their members a certain percentage (usually 20%) for coinsurance, Medicare Advantage will require you to pay a flat fee or copay for every service rendered. It also puts a limit to your annual out-of-pocket expenses, unlike Original Medicare.
Medicare Part D (Prescription Drug Coverage)
Part D is a prescription drug coverage plan offered by accredited private health insurance companies.
Many Medicare prescription drug plans are offered, but no single plan covers all drugs. Keep in mind that the copay for the same drug for each plan may also vary depending on the plan you’re enrolled in.
Medicare Part D is run by private insurance companies, so there’s no guarantee that the same drugs will be covered by your plan at the same rate every calendar year.
These companies have the option to opt-out of or make revisions to their rates and drug lists annually.
You are automatically enrolled in Part D if you are receiving Supplemental Security Income (SSI) or if you meet other automatic enrollment qualifications.
Medicare Supplement Plans (Medigap)
Medigap is a policy offered by private companies that supplements, or helps, in covering some of the costs that Medicare Parts A and B do not cover.
If you are considering enrolling in Medigap, here are a few important things to know:
- You have to be enrolled in Medicare Parts A and B to qualify for Medigap.
- You have to pay a separate premium for Medigap.
- Your Medigap policy only covers you, not your spouse or partner.
- You cannot be enrolled in both Medigap and Medicare Advantage (Part C).
- Prescription drug coverage is not included in Medigap plans.
- Medigap does not usually cover vision, dental or long-term care, private duty nursing, or hearing aids.
- Medigap covers emergency services abroad.
- There are 10 standardized Medigap policies labeled A–N.
- If you live in Massachusetts, Minnesota or Wisconsin, your plans may be different.
Finding The Medicare Plan That’s Right For You
Understanding the different Medicare options available to you will help prepare you when the time comes to select your health insurance coverage.
To learn more about Medicare plans and obtain a personalized quote, consider speaking with a licensed Medicare insurance agent.