The purpose of Medicare is to help reduce some of the financial strain caused by covering healthcare costs later in life. To make the most of the coverage you receive, you have to choose the right plan.
It’s important to note that the costs and benefits related to different Medicare options vary significantly. By asking the right questions, you can find the option that best suits your needs.
What Does Original Medicare Mean?
When someone says “original Medicare,” they refer to Parts A and B. Each of these parts of Medicare covers different things.
Part A will cover all costs related to the care you receive in the hospital. This includes surgery, lab tests, and inpatient services. With Part B, you have coverage that provides payments for preventative services (some exclusions apply), outpatient care, and doctor’s visits. The federal government provides both Part A and Part B.
Will You Have to Pay a Premium for Part A or Part B?
Usually, Part A coverage will remain premium-free if you or your spouse paid Medicare taxes for a minimum of 10 years when you were working. There is also no premium for Part A if you receive Railroad Retirement Board benefits or Social Security benefits when you enroll.
With Part B insurance, you will be required to pay a monthly premium. This is deducted from your RRB benefits or your Social Security benefits if you receive them. In 2020, the premium for Part B coverage will be $144.60 or higher based on your total income.
What Is Everything You Should You Know Related to the Medicare Advantage Plan?
A Medicare Advantage plan is offered by a private insurance company, such as Humana, which is contracted by the federal government. If you hear someone talking about Medicare Part C, they are talking about the Medicare Advantage Plan. With this coverage, you receive everything offered by Original Medicare plans. Hospice care is the only exception to this. Some Medicare Advantage plans provide prescription drug coverage, too.
What Can You Expect to Pay for a Medicare Advantage Plan?
When you opt for Medicare Advantage plans, you won’t pay your healthcare costs yourself. Instead, the federal government will pay a private insurance company to provide your coverage.
Even though there is a monthly cost for these plans, some private insurance companies offer very low or $0 premiums. These low costs are done to help compete for your business. They will also create the guidelines for your copays, coinsurance, and deductible. You can find all this information on private insurance companies’ websites, or you can choose to work directly with an insurance agent from your insurance provider. Similar to someone who purchased Original Medicare, the Advantage plan members must continue to pay the premium for Part B coverage.
Will Medicare Cover Your Prescription Costs?
There are two options for you to consider when it comes to Medicare prescription drug coverage. One option is to select the Medicare Advantage plan that includes coverage for prescription drugs. The official name for this is an MAPD plan.
The other option is to buy a separate drub plan. This is usually called Medicare Part D. It will be added to the Original Medicare plan you have purchased.
The costs that you pay for prescription drugs out of your own pocket, along with coinsurance and copays will vary from one plan to another. Ensure that you check the Drug List for the plan you choose to ensure that the medications you take are included.
What Is Everything You Need to Know About Supplement Medicare Insurance?
Medicare Supplement insurance, which is often referred to as Medigap coverage, helps fill in the gaps of coverage for anyone with Original Medicare. The best Medicare supplement plans depend on your personal needs and your current state of health.
You will have to pay a premium for the Medicare supplement plan you choose, along with the Part B premiums you are already paying for. It is important to note that Medicare Supplement plans aren’t available to purchase if you have a Medicare Advantage plan.
Can You Get Medicare if You Have a Preexisting Condition?
Even with a preexisting condition, you can enroll in the Original Medicare Plan or a Medicare Advantage Plan. It is important to remember that if you have end-stage kidney disease, you will not be eligible for a Medicare Advantage plan. Also, with a Medicare supplement plan, if you don’t sign up when you are first eligible, your insurer may impose a waiting period before your coverage goes into effect for a preexisting condition. There are exceptions to this that will qualify you for automatic and guarantee acceptance.
Can You Choose Your Doctor?
If you choose original Medicare, you don’t need a primary doctor. You can go to any doctor who takes Medicare. However, if you have a Medicare Advantage plan, your doctor depends on choosing a preferred provider organization (PPO) plan or a health maintenance organization (HMO) plan. Get to know the difference in PPO vs. HMO to know what is right for you.
Will All Healthcare Facilities and Doctors Accept Your Medicare Plan?
While Medicare is widely accepted, it is important to note that it is not universal. As you review the different plan options that are available, you need to pay close attention to what the providers who are in your area will accept. The goal of Medicare is to ensure you have access to healthcare, so just make sure you choose a plan that facilitates your needs, no matter what they are or what your current state of health is.
Making the Right Decision
When it comes to health insurance coverage, there are a lot of things to consider. It might be confusing at times, but take your time to review everything thoroughly. Be sure to keep the information here in mind to get a plan that suits your needs now and that will evolve as your healthcare needs change. This will ensure you can receive the healthcare services needed during your Golden Years.