Understanding Your Medicare Options

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May 12, 2020

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Youve earned that red, white and blue Medicare card, and deserve all the coverage that comes with it. But there are other health plan options available, and you may find that the extra benefits and comprehensive all-in-one coverage of a Medicare Advantage plan fits you and your budget best.
Original Medicare vs. Medicare Advantage
Original Medicare (Part A and Part B) is the federal plan that provides hospital and medical insurance coverage to those who qualify. For the basics of your health care, it works well. You get easy access to most of the care you need, with minimal paperwork and widespread acceptance by doctors and medical facilities.
But, even though Original Medicare is intended for older adults, it does not cover many of the health issues that become more critical as we age - like prescription drugs, vision, hearing and dental. And it may leave you open to financial burdens that dont fit your budget.
So its no wonder that the Medicare Advantage category is growing rapidly as our country gets older. (Enrollment in Medicare Advantage plans has tripled since 2004*).
Medicare Advantage plans (also known as Medicare Part C) are contracted with the federal government to provide Medicare coverage. These plans must provide all the benefits that Original Medicare offers, and often include additional benefits for more complete health care coverage. And because they operate as managed care programs, Medicare Advantage plans can provide all this coverage, and limit your financial risks as well.
Coverage you cant get from Medicare
Most Medicare Advantage (MA) plans include prescription drug (Medicare Part D) coverage for your medication needs. Look for plans that have low or no copays on widely used generic drugs, and offer additional savings on higher cost prescriptions at in-network or preferred pharmacies.
Dental, vision and hearing issues can become more prevalent as we age, and coverage for these important conditions can be key to maintaining a healthy, functional lifestyle. These benefits are often included in MA plans; the coverage can vary from plan to plan, so try to find one that can help offset the costs of big-ticket items like hearing aids, glasses and dentures.
Protecting your finances
Because incomes often become limited or fixed at the same time health issues increase, Medicare Advantage plans can be a good financial solution as well.
With deductibles, copays and co-insurance, Original Medicare generally covers only 80% of medical expenses. Youd be responsible for the other 20%. Keep in mind there is no limit on this expense, so a chronic health condition or extended hospital stay can be financially devastating.
Medicare Advantage plans cover many of the out-of-pocket costs that Original Medicare does not; you pay little (or nothing) of that remaining 20%. And, while you still must pay your Medicare Part B premium, many MA plans offer coverage with no additional plan premium. In any case, MA plans have maximum out-of-pocket limits, so you know exactly what your potential financial liability looks like.
(In 2019, the average out-of-pocket limit for Medicare Advantage enrollees is $5,059*.)
Make sure that you use doctors, specialists, hospitals and services that are in your plans network to keep your coverage affordable and take the utmost advantage of your Medicare Advantage membership.
Do your research.
Once you become eligible, youll need to enroll in Medicare and choose a health plan. Then, every year, the Annual Election Period (October 15 December 7) allows you to change your coverage, so thats a good time to review your current health, financial situation and Medicare options to make sure that you still have the plan thats right for you. You can find out more at www.medicare.gov.

*Kaiser Family Foundation
https://www.kff.org/medicare/fact-sheet/medicare-advantage/
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Editors Note: This article was contributed by PA Health & Wellness.

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