If you’re eligible for Medicare, you might be wondering what kind of benefits the program brings. Since there are multiple tiers and options to choose from, there might be one that’s better for your situation than others and save you money in the process.
Medicare coverage is different from one plan to another and it’s always best to talk to your healthcare provider so you can assess which one best fits your health goals and needs. If you’re over 65 years of age and you’re not experiencing any serious issues, you might be fine with just the original plan, but if you’re already on certain medication, you will probably get the best Medicare benefits with a plan that covers your prescription medication as well.
Benefits and Plans
You first become eligible to sign up for Medicare three months before your 65th birthday. The exception is for those who have a diagnosed disability, ALS (Lou Gehrig’s disease), or End-Stage Renal Disease (ESRD). Once you start inquiring about which Medicare services best fit your needs, their official website guides you and educates you on all you need to know to find the best option for you.
You learn about the parts of Medicare, general costs, how it actually works, and what happens if you or your spouse are still working past 65 years of age. Medicare insurance is divided into Medicare Parts, also known under the letters A, B, C, and D.
Your original and most basic Medicare insurance includes Part A & Part B, while Part C defines Medicare Advantage Plans.
- Part A – also known as hospital insurance, covers in-patient hospital care, skilled nursing care facilities, hospice care, and home health care
- Part B – also known as medical insurance, covers most services from doctors and other health care professionals, outpatient care, many screening and preventative services, vaccines, wellness visits, and durable medical equipment such as wheelchairs, hospital beds, crutches, walkers, and other.
- Part C – Advantage Plans that combine a variety of advanced plans under one umbrella
- Part D – drug coverage which helps cover the cost of medication and prescription drugs. It cannot be chosen by itself, but rather as an addition to either the Original Medicare or Medicare Advantage Plans.
- Supplemental Insurance (Medigap) – Additionally, you can also choose to pay for Medigap, which is extra insurance available to purchase from private companies. Medigap helps share your costs of Original Medicare, but the actual benefits depend from company to company.
Combining Part A and Part B, the Original Medicare allows you to take services from any US health provider that accepts Medicare and in most cases, you don’t need a referral to see a specialist. Your Part A (hospital insurance) is covered completely and with Part B (medical insurance), you pay 20% of the Medicare-approved amount after you meet your deductible.
That being said, you pay a monthly premium for part B, and depending on whether you choose to take Part D or not, you pay extra for that as well. The biggest problem comes with out-of-pocket pay – there is no yearly limit, meaning your out-of-pocket costs could easily pile up and become too high. That’s where supplemental coverage such as Medigap or any other private supplemental insurance comes in handy.
Additionally, the Original Medicare does not cover hearing, vision, or dental services, which is why many seniors have to choose the more expensive, Medicare Advantage Plan.
The Original Medicare is an excellent option for many seniors who don’t have severe illnesses or go to the doctor very often. It covers the most basic and medically necessary services and supplies in hospitals and other healthcare facilities throughout the US. In the case of foreign travel, you do need to buy an additional policy.
Medicare Advantage Plan
This advanced plan is offered by private companies and usually bundles up Part A, Part B, and Part D, offering more coverage for a higher monthly premium. It’s approved but since it’s offered through private companies, it does come with some advantages and disadvantages.
In the majority of cases, you need to use just those healthcare providers who are in your plan’s network, with exceptions for emergency care. You might also need to use a referral in more cases than not, but your out-of-pocket costs are usually lower than in the Original Medicare.
When it comes to payment, you pay for the Plan B premium, but you usually have to pay for the overall plan’s premium too. That being said, you do have a yearly limit for out-of-pocket costs and when you reach it, you don’t pay for any further item or service covered. In the case of Medigap, when you’re under the Medicare Advantage plan, you aren’t eligible for purchasing it.
If you choose any of the Medicare Advantage Plans, you will be covered for everything you would under the Original plan with additional extra services such as vision, hearing, and dental. Prescription drug coverage is most commonly included in all plans.
Medicare Advantage Plans usually don’t cover outside of the US, but some may offer supplemental benefits for emergencies and other urgent services abroad.
Many seniors wonder about the Medicaid program and services. This federal and state program offers health coverage for those with limited income and resources. It provides benefits such as preventive services and nursing home care, and it can even be used as Medicare supplement insurance.
Once you meet the requirements, you are ready to join Medicare. Usually, you only need to sign up once for your Medicare plan, but each year, you have the option to switch it up. This is convenient in the event something occurs and you need to add Medicare Part D to your existing plan. When you first sign up, you automatically get Part A and Part B. If you don’t do anything other, you will be joining Original Medicare. In case you want to sign up for Medical Advantage Plan, you will need to do it in the next step. Then, you also get to choose whether you want Part D and supplemental insurance or not.
Medicare is federal health insurance offered to those 65 years and over as well as those receiving Social Security disability benefits. Which plan you choose to get will depend on your health state and needs. Some people might only need the Original Medicare plan, but others might need the extra benefits Advantage Plans offer. You can find all the information on their official website or call about options. You can also signup for email updates and start collecting information before your 65th birthday so that once the time for signup comes, you’re well equipped with up-to-date news and potentially new options.