Making Sense of Medicare
Medicare is confusing, and your choices when you go on Medicare are critical. You are inundated with telephone calls, mail, and television advertisements. There is a lot of information to sort through. I am dedicated to helping you make an educated and informed decision about your healthcare. I can explain how Medicare works, answer your questions and review your options. Below are some questions you may want answers about Medicare before enrolling.
Do you have to enroll in Medicare when you turn 65 if you continue to work and have health insurance through your employer?
How do you go about enrolling in Medicare?
Will Medicare cover all your medical expenses?
Are pre-existing health conditions covered, or is there a waiting period?
Should you choose a Medicare Supplement or a Medicare Advantage Plan?
Overview of Medicare
Part A of Medicare
Hospital Inpatient Care
Skilled Nursing Facility/Rehab and Recovery Care
Home Health Care
Part A of Medicare is free for most people
Part B of Medicare
Part B of Medicare provides Outpatient medical services. You can receive these outpatient medical services and treatments at a doctor’s office, hospital, or clinic.
There is an annual deductible of $226 for Part B medical services, and after the deductible is met, Medicare only covers 80% of Part B medical expenses.
You pay a monthly premium to the government for your Part B coverage. If your income exceeds a certain amount, your premium could be higher than the standard premium. The standard Part B premium for 2023 is $164.90.
Medicare Supplement (Medigap)
Medicare Supplements (Medigap) offered by insurance companies only supplement Medicare by filling in the gaps in Medicare that you would have to pay (deductibles, coinsurance, and copays). Medicare Supplements are considered your secondary coverage.
With Medicare, you have nationwide coverage for doctors and hospitals – you can use it anywhere in the United States. If a doctor or hospital accepts Medicare, they will also take your Medicare Supplement, regardless of which company provides the coverage.
Medicare only covers 80% of doctor office visits, outpatient medical services, and treatments, leaving 20% coinsurance. Medicare Supplements cover the 20% coinsurance.
Medicare has a sizeable deductible of $1,600 for inpatient hospital care and expensive daily copays. Medicare Supplements cover the deductible and the daily copays.
Between Medicare and your Supplement, you will know what is covered and your costs for every medical service and treatment, leaving you with low, predictable medical expenses.
Part C of Medicare (Medicare Advantage)
Part C of Medicare refers to private health insurance plans. Insurance companies approved by the Center for Medicare and Medicaid Services offer Medicare Advantage plans. These private health plans are not considered supplemental Medicare coverage.
These plans must provide the same benefits as Original Medicare (those covered under Parts A and B); however, each plan can charge different out-of-pocket costs and have different rules for getting services. If you enroll in one of these plans, you must continue to pay the Medicare Part B premium of $164.90.
Medicare Advantage or Disadvantage
You leave Medicare, and your primary coverage is with an insurance company.
The insurance company approves your claims and pays all claims.
Advantage Plans have networks (HMO or PPO).
If you want to go to a doctor or hospital not in the plan’s network, you’d have to pay all or a significant portion of the cost.
When you travel, you are out of network.
Advantage Plans require pre-authorization for many medical services and treatments, which could mean delay or denial of medical care.
You could face substantial out-of-pocket costs with an Advantage Plan, as much as $8,300 in a calendar year. Some plans set lower limits.
Part D of Medicare
Part D of Medicare is the prescription drug benefit that covers outpatient prescription drugs at your pharmacy.
Private insurance companies with government contracts offer prescription drug coverage.
You pay a monthly premium to an insurance company for your Part D plan. You will have an annual deductible to meet and pay copays or a percentage of the drug’s cost.
Each Medicare prescription drug plan has a list of covered drugs called its formulary.