How To Pick The Right Medicare Plans For You
Crystal Manning Medicare Advisor
Jul 27, 2022
Pennsylvania - Greater Pittsburgh Area
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Deciding whether to enroll in Medicare is an important decision, so you will want to make sure you are as knowledgeable about this health coverage program before you make it. You also need to be aware of enrollment requirements and timeframes. If you miss your initial enrollment period, which begins three months before you turn 65 and runs until three months after, then you will need to wait until a general enrollment period opens, unless you qualify for special enrollment. Also, keep in mind that if you fail to sign up for Part B or prescription drug plan (part D) when you first become eligible and do not have an approved exception, you face penalty premiums for each year you do not register.
What is Medicare? Medicare is a federal health insurance program, primarily for people who are 65 years and older. It has four parts, each of which has a distinct intent:
• Medicare Part A: Covers hospital stays, care in a skilled nursing facility, hospice care and some home health. Deductibles & copays are the patient responsibility.
• Medicare Part B: Covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Medicare pays 20% of all covered expenses – except for the annual deductible.
• Medigap: Supplemental coverage for Parts A and B provided by private insurers that in most cases eliminates all copayments, coinsurance, and deductibles.
• Medicare Part C (also known as Medicare Advantage): Supplemental coverage provided by private insurers that often reduces copayments and coinsurance and may include dental, vision and prescription coverage.
- Medicare Part D: Supplemental plans that cover prescription drugs costs for Parts A and B supplemental plans. Prescription coverage is mandated by Medicare. You will incur a penalty if you do not have creditable prescription coverage which remains in effect for as long as you have coverage.
Medicare C or Medigap: what are the differences? Now you have Medicare A & B how can you avoid the high copays & deductibles from Medicare? You cannot purchase both Medicare Part C and Medigap. You will need to choose the option that best fits your needs.
Here is how they compare:
Medicare C (Medicare Advantage) --- (Follow Rules)
• Lower premiums
• Higher out-of-pocket costs that vary by plan; each plan has an out-of-pocket maximum.
• HMO or PPO option: possible limited in-network doctor selection or out-of-network rules.
• Referral to see specialist often required.
• Usually only local or regional coverage.
• Usually includes Medicare Part D as part of the premium.
• Some include extra coverage for vision, dental and hearing aids and exercise programs.
Many Medicare Advantage plans offer zero to various premiums. With more Medicare Advantage plan options being sold by more providers, the increased competition between insurance companies helps keep costs low for consumers. And with more benefits being approved for use, plan providers may gain even greater flexibility with their pricing and coverage offerings.
The Affordable Care Act (also known as Obamacare) put an incentive system in place for Medicare Advantage plans. Beginning in 2012, plans that provide high-quality care will receive a bonus or rebate. By law, the bonus money must be reinvested in additional plan benefits.
Going forward, Medicare Advantage plan providers will no doubt continue to adapt and improve the quality of the plans they offer to meet these bonus requirements. In addition to the bonus program, Medicare issues star ratings for all Medicare Advantage plans each year, and these Medicare Star Ratings can be a large point of emphasis for shoppers. In 2018, Centers for Medicare and Medicaid (CMS) expanded its definition of the “primary health-related” benefits that insurance companies can include in Medicare Advantage plans. As a result, new benefits were available to be added to some Medicare Advantage plans.
These new benefits may include services such as:
• Home-delivered meals
• Air conditioners for people with asthma
• Transportation to doctor’s offices
• Grab bars in home bathrooms
If you sign up for Medicare Advantage, review your coverage annually. Coverage, benefits, and costs of Medicare Advantage plans change each year.
Reviewing your plan could save you money, help you find a better coverage fit — or both.
Medigap (Medicare Supplement Insurance) --- (Peace of Mind)
• Higher premiums.
• Usually, Medicare annual deductible, which is $203 in 2021, depending on the plan you choose.
• Accepted everywhere that Medicare is accepted.
• Usually, referrals are not required to see a specialist.
• Generally accepted in every state or U.S. territory and some plans may be accepted internationally when traveling.
• Medicare Part D must be purchased separately.
• Coverage for extras must be added through additional plans.
• Note -- Those who need frequent medical care, or like to budget with fixed costs, often choose Medigap to keep their total medical costs flat.
Choosing the right insurance plan is the most important decision you will make for your future health. You need to make some of the most consequential decisions about Medicare at a time when you know the least about Medicare. As a licensed Medicare Advisor, Crystal Manning can assist with many options that are best for you. Contact her at 412-716-4942 or crystalmanning33@gmail.com.
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Crystal Manning Medicare Advisor
Medicare Insurance 10008 Pine Ridge Dr, Wexford, Pennsylvania, 15090As we approach retirement, one of the greatest concerns is determining the cost of health care. Health care will likely be your biggest expense during the golden years. Obviously, these costs are a tough number to nail down and one that will vary by person, but there are estimates available. Remove the fear, uncertainty, and costly mistakes from the Medicare enrollment process. Call for a one-to-one, no charge consultation.