Choosing a Medicare plan can be complicated. Trying to understand the benefits and costs of Medicare Parts A, B, and C, Medicare Supplement plans A through N, and Medicare Advantage plans -- each of which vary by insurance carrier -- is a daunting task.
Fortunately, it’s entirely possible to simplify the process and find the plan the best fits with your healthcare and budgetary needs.
Start With You
Before you consider the options available to you with Medicare, first analyze your own healthcare needs. Consider whether you have a medical condition that requires ongoing treatment from a specific doctor, if you require regular prescription refills, or if you would prefer to join a plan that provides extra benefits, such as a free gym membership.
Next, reviewing your annual budget will help you decide how much coverage you need. There are several aspects to healthcare costs, including monthly premiums, annual deductibles, copays and other out-of-pocket expenses that can impact the amount you spend each year. Once you’ve decided how much you’re prepared to pay, you can determine the type of Medicare plan that best suits your needs.
Understanding Your Options
Medicare offers a wide variety of plans for you to choose from. “Original Medicare” is the Federal health insurance plan for those 65 and older and certain disabled and other beneficiaries; it is also known as Medicare Parts A and B. Medicare Part A covers hospital stays, skilled nursing facility care, some home health visits, as well as hospice care. Medicare Part B covers doctor office visits, outpatient care, some preventive services, including mammograms and colonoscopies. Medicare Part B charges a monthly premium (there is no monthly premium for Medicare Part A if the beneficiary has worked 40 quarters—or 10 years—and paid payroll taxes). Both Medicare Part A and Part B charge deductibles, copays, and/or coinsurance.
Medicare supplement plans, also known as Medigap plans, can help fill in the gaps that remain from original Medicare Part A and Part B plans, such as the deductible, copay and coinsurance. Medicare supplement plans are offered by private insurance companies and will typically include an additional monthly premium.
Medicare Part C is Medicare Advantage, which has the benefits of Medicare Parts A and B, and may include additional benefits like Medicare Part D for prescriptions, gym memberships, tablets, hearing, vision and more. To enroll in a Medicare Advantage plan, a Medicare beneficiary must be enrolled in Medicare Parts A and B. In many cases, Medicare Advantage plans charge no additional premium. Like Medicare supplement plans, Medicare Advantage plans are offered by private insurance companies. However, Medicare Advantage plans are paid by the Federal government to cover all the services that Original Medicare covers, whereas Medicare supplement plans are funded entirely by monthly premiums paid by its enrollees.
When it comes to a Medicare supplement plan, it’s important to note that these plans often involve underwriting. When a new Medicare enrollee joins a Medicare supplement plan, underwriting is not required. However, if at a later time a Medicare beneficiary desires to enroll in Medicare supplement or to switch from one Medicare supplement plan to another, the beneficiary will be asked health questions to determine if they pass the plan’s underwriting. If your health declines and you are unable to pass the underwriting, you will not be able to enroll or switch your Medicare supplement plan.
Choose the Right Plan
Once you know what you need from your healthcare, you can compare available plans and decide what best suits you. You might decide you need the additional benefits that are available in a Medicare Advantage plan. Or, perhaps you prefer to have some of your out of pocket expenses covered by a Medicare supplement plan. You might even decide that Original Medicare is sufficient for your needs. Either way, it’s important to take the time to research the various plans available in your area. You may find that some plans offer better discounts for your prescriptions or more benefits that meet your health requirements.
Selecting the right Medicare plan for your needs doesn’t have to be overwhelming -- just take it a step at a time. Start by considering your healthcare needs and budget, then review the Medicare plans available in your area. After that, it’s all about comparing plans and picking the best option.
Jan Dubauskas is a healthcare expert, enthusiastic insurance pro, attorney and mom serving as Vice President of healthinsurance.com.
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