A senior becomes eligible for Medicare every eight seconds. This government-run health insurance plan is a common choice for many people 65 and older, but some are often surprised to learn (sometimes the hard way) about gaps in coverage. For those approaching 65, it’s time to learn about the different Medicare programs and the resources they provide. For more detailed descriptions of plans available in your state, consider talking to a Medicare adviser. In the meantime, you can get acquainted with the basic concepts.
Plans at a Glance
If you’re eligible for Medicare, make sure you understand what is and isn’t covered. Depending on your needs and financial means, you may want to learn about supplemental plans that can help fill the gaps. To make that decision, familiarize yourself with the differences:
- Medicare Part A provides coverage for hospitalization, limited stays in a skilled nursing facilities and some home health services like hospice care. This is part of the Original Medicare plan.
- Medicare Part B covers visits to the doctor, home healthcare, durable medical equipment, outpatient procedures and therapy, lab work, X-rays, mental health counseling and ambulances. This is part of the Original Medicare plan.
- Medicare Part C, also called Medicare Advantage, is an alternative plan that includes Parts A and B coverage, but certain plans, like those offered through Humana, also provide extras like vision, dental, hearing, Silver Sneakers and prescription drug coverage (Part D). You must enroll in Original Medicare before enrolling in a Medicare Advantage plan.
- Medicare Part D is optional prescription drug coverage. Seniors enrolled in this program pay a monthly premium and copays for their medications.
- Medigap is a supplemental Medicare plan offered by private insurers that provides additional coverage to go along with your Original Medicare. There are a lot of variations in plans, so it’s crucial you review each plan carefully. If you opt for a supplemental plan, it has to be Medigap OR Medicare Advantage — you can’t have both at the same time.
Now that you know a bit about the different programs, you can weigh some important cost factors to help make your decision.
Costs at a Glance
The costs for Medicare can change every year, so look for the most up-to-date information you can find.
- Premiums: Medicare Part A and Part B premiums depend on the taxes you paid over the course of your life and your income. Most seniors can expect to pay between $130 and $450 a month in premiums. Medicare Advantage Plans and Part D premiums vary depending on the insurance providers criteria.
- Deductibles: Medicare coverage is convenient, but it is not free. Medicare Parts A and B require you to pay a deductible before the insurance company will pay a claim. Like premiums, these costs are subject to change, but you can roughly expect to pay between $185 and $1500 in deductibles each year.
- Copays: Medicare recipients will often have to pay a flat fee — a copay — for healthcare services. Copays are different depending on the type of service or procedure. For example, visiting your primary care doctor typically has a lower copay than seeing a specialist or checking into an urgent care clinic.
- Coinsurance: Like copays, coinsurance is a fee you pay to receive services under Medicare. However, instead of a flat fee, coinsurance payments are a percentage. Typically, you can expect to pay between 20 percent to 40 percent on a Medicare plan.
Remember, the enrollment period is open three months before and after you turn 65, as well as from January 1–March 31 each year. Figure out when you are eligible to enroll and make sure to do your research long before it’s time to choose a plan. This starter guide can help you become familiar with the terms and lingo you need to know to navigate Medicare. Understand the benefits and consequences of specific Medicare plans so you can feel confident and comfortable in your healthcare coverage.
Guest Author: Sharon Wagner
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