Your Healthcare and Finances Depend On Making Smart Choices
Whether you’re about to turn 65 and enroll in Medicare for the first time or your needs, have changed since you first joined the program, selecting a Medicare plan can be confusing and overwhelming. But choosing the right coverage has a significant impact on your health and finances, so it is critical that you make smart decisions. The first smart decision you can make is finding a reputable health insurance broker specializing in Medicare plans.
Here are seven questions to ask about selecting a Medicare plan once you find the right broker:
1. What does selecting a Medicare plan mean?
Medicare covers a substantial portion of the healthcare expenses you incur after enrolling, just as your current private insurance does. But like your existing coverage, Medicare Parts A and B, sometimes called “Original Medicare,” does not cover all costs of care, treatments, and other services. As with private insurance, you will be on the hook for copayments, deductibles, coinsurance, and even premiums. And as your healthcare needs increase with age, so too does the amount of money you may need to spend on your care.
Selecting a Medicare plan means enrolling in a plan issued by a private insurance company to cover those costs that Medicare doesn’t pay for or provide benefits not offered by Medicare Parts A and B. There are two types of plans you’ll want to discuss with your broker: Medicare supplemental insurance and Medicare Advantage.
2. What’s the difference between Medicare supplemental insurance and Medicare Advantage?
Medicare supplemental insurance, also called “Medigap” coverage, takes care of the “gaps” in Medicare, paying for care that could otherwise cost you tens or hundreds of thousands of dollars over time.
These policies, issued by private companies rather than the government, require the payment of monthly premiums that are significantly less than the expenses the policies cover. Medigap plans allow you to choose or keep your doctor as long as the physician or clinic accepts Medicare insurance. There are many Medigap plans varying in cost, level of coverage, and area of availability.
Medicare Advantage plans, also known as Medicare Part C, provide an alternative to Original Medicare Parts A and B. As with Medigap coverage, Medicare-approved private health insurers issue Medicare Advantage plans. By law, these plans must offer at least the same benefits as Original Medicare, but they often include expanded coverage for vision or dental care, prescription drugs, or wellness programs.
Related Reading: Why Do I Need Medigap Insurance?
3. How much might I have to pay out-of-pocket without Medigap coverage?
Calling the amount of costs not covered by Medicare “gaps” dramatically understates the amount of money you may need to pay for your care. They are more like canyons. A quick look at out-of-pocket costs for Medicare Parts A and B illustrates how much of a hit you could take without Medigap coverage.
Medicare Part A primarily addresses inpatient hospitalization. While Part A covers up to 60 days of hospitalization without copays or coinsurance, you’ll still need to pay a deductible of $1,484 in 2021.
After that 60th day (in a benefit period, meaning it doesn’t need to be 60 consecutive days), the out-of-pocket costs can get out of hand. Each additional day you are hospitalized from days 61-90 will cost you $371 in coinsurance. The figure doubles to $742 each day for days 91 and beyond, and if you are in the hospital for 150 days, your hospital coverage runs out altogether.
Cost-sharing under Medicare Part B is similar. You are responsible for a Part B deductible, which is $203 in 2021. After that, Part B only pays 80 percent of approved services. This means that you must cover 20 percent of the cost of all your doctor visits, ER trips, blood tests, X-rays, surgeries, durable medical equipment, and even astronomically expensive treatments like chemotherapy.
4. Can I still go to my preferred physician, specialist, or hospital?
Under Original Medicare, you can see any physician, hospital, or other providers that take Medicare. In most cases, you can see a specialist without a referral. If you enroll in a Medicare Advantage plan, you will probably need to use physicians who are part of the plan’s network.
5. Do any Medicare plans cover my prescription drug costs?
Original Medicare does not usually cover all prescription drug costs. Medicare Part D provides Medicare beneficiaries access to retail prescription drugs with affordable copays.
6. Are there Medicare plans that cover hearing, dental, and vision care?
Medicare Advantage plans include Part A and Part B coverage and can also include prescription drug, hearing, dental, and vision coverage. Not only do Medicare Advantage plans have extra benefits, but they are also typically very affordable.
7. How do I use my Medicare insurance coverage?
After enrolling in Medicare, you receive a red, white, and blue Medicare card in the mail. This card shows whether you have Medicare Part A, Part B, or both. If you enroll in a Medicare Advantage plan, you will get an additional card. As you’ve done with your private coverage, you should keep your cards with you and provide them to your doctors, hospitals, or other health care professionals when you get care.
Selecting A Medicare Plan Doesn’t Have To Be Confusing.
Navigating the many different options available when selecting a Medicare plan can seem like a daunting task. But it doesn’t have to be. At Southwest Health Insurance Experts, our experienced, independent Medicare brokers can help you with all of your Medicare needs, from plan selection to enrollment to education and more.
Contact Southwest Health Insurance Experts today to schedule a free consultation to discuss your Medicare questions and needs.
More From Our Medicare Blog:
When I’m 64: How Should I Be Preparing For Medicare?
Do You Have to Be on Medicare Health Insurance When You Turn 65?