You received the good news that you have qualified for Medicare (either by age or disability). Once that relief sets in, you will likely begin considering what type of Medicare coverage is right for you and whether or not you need a supplement. You will find that there is a lot of information out there. What follows is my attempt to simplify the process of understanding the coverage options while making sense of the basics of Part A, B, C and D.
Firstly, I should explain that there are two main types of Medicare coverage; Medicare (Part A and B), and Medicare Advantage Plans (Part C). The following is a summary of the basics of each type of coverage:
“Traditional” Medicare – Part A and B
As stated above, traditional Medicare coverage involves two parts. Part A is basically your hospital insurance and Part B is your medical insurance. The coverage is through Medicare and you can be seen at any hospital, doctor’s office or medical facility that accepts Medicare. The cost for this coverage is broken down into two parts. Most people do not pay a monthly premium for Part A. However, you are responsible for hospital inpatient deductibles and coinsurance payments. Concerning Part B, the monthly premium is around $134.00, depending upon your income.
Note: More information concerning the costs associated with this plan can be found on the Medicare website via this link: https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html
Medicare Advantage Plans – Part C
You can opt for a Medicare Advantage Plan (Part C) in place of traditional Medicare, if you choose. This type of coverage encompasses both Part A and B and is provided by private insurance companies that have been approved by Medicare to offer this coverage. Unlike with traditional Medicare, these plans usually restrict you to utilizing hospitals, doctors and other providers approved within the plan guidelines. In some cases, you are allowed to see whomever you choose, however you face paying more or all of the costs involved. The cost for these plans differ based on the plan but often times involve a monthly premium, copays or coinsurance and sometimes restrictions on how often you can see a doctor or have a test.
Note: If you are interested in running a cost analysis of several of these types of plans, visit the Medicare Plan Finder at https://www.medicare.gov/find-a-plan/questions/home.aspx.
Prescription Drug Coverage – Part D
If you choose the traditional Medicare coverage, you will need to decide if you wish to purchase a supplement to cover the costs of prescription drugs. If so, you will need to find a plan through a private company that has been approved by Medicare to provide this coverage. You will pay a monthly premium for the coverage, depending upon what plan you choose. If you wish to compare plans, you can reference the link above for the Medicare Plan Finder.
If you are going the Medicare Advantage Plan route and prescription drug coverage is important to you, choose a plan that includes Part D coverage within the plan. These plans that include Part A, B and D coverage are often called “MA-PD”s.
Note: Remember that you cannot enroll in Medicare Prescription Part D coverage if you are already enrolled in a Medicare Advantage Plan. Your Medicare Advantage Plan will terminate your coverage and you will be placed back on traditional Medicare.
There are also Medicare MSA plans, Medicare Cost Plans, PACE for the elderly and a boat load of other considerations. This is all complicated and the internet is loaded with information. If you get lost, give me a call. I would be happy to sit down with you and make sure you understand how all of this works. Or, you can always call Medicare and ask questions at 1-800-MEDICARE. May you find the plan that works best for you!