Part A, donut hole, late enrollment penalty — sometimes it seems like Medicare has a language all its own. If you or a loved one are making the transition to Medicare, you probably have lots of questions. Don’t feel discouraged! Here are three tips for becoming an informed Medicare consumer.
1. Know Your Plan Options
There are three health insurance solutions for Medicare beneficiaries.
The first, most basic option is Original Medicare. The federal government manages Original Medicare through an agency called the Centers for Medicare and Medicaid Services, or CMS. Original Medicare includes hospital care (called Part A) and medical insurance (Part B), and covers many health care related costs. It’s a fee-for-service program, though, meaning that for most services and medical supplies, beneficiaries pay some part of the cost. It also doesn’t pay for prescription drugs (Part D), so beneficiaries must either enroll in a stand-alone prescription drug coverage (called a prescription drug plan, or PDP) or enroll in more comprehensive coverage (see Medicare Advantage plans below). For most people, Social Security benefits pay for the premium associated with Part A. There is a monthly fee for Part B benefits.
Because Original Medicare leaves seniors responsible for some costs, two more options were created. These offer added coverage and peace of mind.
The second option is a Medicare Supplement plan, sometimes also called a Medigap plan. It works in addition to Original Medicare. For an additional premium, these plans cover some or all the costs that Original Medicare doesn’t provide for, so that your out of pocket costs are lower. Medigap plans can cover costs like copays and deductibles, but they generally don’t cover things like long-term care or vision care. They don’t include prescription drug coverage (called Part D), either, so beneficiaries still may need a PDP, for an additional monthly premium.
The third option for Medicare coverage is a Medicare Advantage (MA) plan. When MA plans include Part D benefits to cover prescription drugs, they’re called Medicare Advantage Prescription Drug plans (MAPD). Administered by private insurance companies like Independence Blue Cross (Independence), these plans provide all of your Original Medicare benefits as well as coverage that’s broader and more robust.
These plans might remind you of the options available from your employer when you or your spouse was working; they tend to be best for individuals who would like to simplify their coverage so that they receive all their benefits from one insurance provider. MA and MAPD plans cover everything that Original Medicare pays for plus additional benefits, like hearing aids. Beneficiaries must continue to pay their Part B premiums in addition to their MA or MAPD premium, but there are options to choose from at a range of price points, including some with a $0 premium, like our Keystone 65 Basic HMO plan.
2. Review Your Costs
Once you understand the three options for Medicare coverage – Original Medicare, Medicare Supplement, and Medicare Advantage – it’s time to think about health care costs. Health care costs are widely variable, depending on everything from a beneficiary’s overall health to where they live and how easily they can access doctors and hospitals. There are a few key things to think about when considering health care costs.
- Do you mind sharing in the cost of your health care like paying a copay for seeing a provider, or do you prefer to a higher monthly premium to avoid paying every time you see the doctor?
- Are you looking for an all-in-one plan that includes coverage for your medical care and Part D prescription drugs?
- Do you mind staying within a network of doctors or do you want the flexibility to see any doctor that accepts Original Medicare?
3. Take Advantage of Available Resources
No one has to navigate Medicare alone. Register for a live seminar to learn more about the basics of Medicare. Log in for a webinar, reach out to a local agent who can come to your home for a one-on-one consultation about your plan options, or call us if you have questions! Our agents are standing by to help talk through your questions. Take advantage of the resources available to you, and you’ll be an informed Medicare consumer in no time.
Website last updated: 9/1/2018
Y0041_HM_18_67727 Accepted 9/16/2018