Medicare can be a huge help to seniors, allowing them to receive preventive care, treatments, and specialty services to protect their health. However, deciding on a plan gets very complicated. There's just so much information out there to sift through! Here is a quick guide to get you started on your research so you can find the perfect plan to suit your individual needs.
Understand What Basic Medicare Covers
First of all, it’s important to understand what’s covered (and what’s not covered) by the federal Medicare plan, called Original Medicare or Medicare Part A and B. Medicare Part A covers things like inpatient hospital care, short-term skilled nursing care, and some degree of home health care. Part B covers preventive services and medically-necessary services, like diagnostic tests and health screenings.
There are several things that Original Medicare does not cover, including:
- Long-term care
- Dental care and dentures
- Vision services
- Complementary therapies, like acupuncture
- Hearing exams and hearing aids
Know Your Options for Prescription Drug Coverage
Original Medicare only covers a few, limited drugs. For more inclusive prescription drug coverage, you will need to enroll in Medicare Part D — this is provided by private insurance companies. Part D can be added to Original Medicare, but most supplemental Medicare plans include this already. CNBC recommends reviewing your drug coverage each year, since plans may change in terms of price or which drugs they cover.
Learn About Your Supplementary Options
Many seniors choose to supplement their basic Medicare with private insurance plans. Your options for this include Medigap and Medicare Advantage.
One in three seniors with Medicare are enrolled in a Medicare Advantage Plan. Medicare Advantage (also referred to as Medicare Part C) includes Part A and Part B coverage with an additional array of supplementary coverage options. Certain plans, such as Humana Medicare Advantage, provide vision and dental coverage as well as a variety of wellness programs, like SilverSneakers fitness. Medicare Advantage plans allow seniors to pick the ideal plan for their individual needs rather than sticking to the broad coverage provided by the federal program alone.
Medigap is another option for supplementing your Original Medicare coverage. Medigap protects you against the leftover out-of-pocket medical expenses, deductibles, and co-payments that Medicare doesn’t cover. Like Medicare Advantage, Medigap is provided by private companies and broken into several different plans. It’s important to shop around before choosing. Some plans will have higher premiums but lower out-of-pocket expenses, and vice versa.
Decide What’s Most Important to You
You cannot have both a Medicare Advantage and a Medigap policy, so it's important to consider your criteria carefully before choosing one or the other. According to Investopedia, Medicare Advantage plans generally cover more services. These are the better option if you're interested in wellness programs or use a variety of healthcare services. Medicare Advantage plans also tend to have lower premiums. On the other hand, Medigap plans may be better if you travel outside of the country often or you're looking to save money on out-of-pocket expenses.
Before signing up for any Medicare plan, make sure your plan of interest covers the doctors, specialists, hospitals, and other facilities you want to visit. It’s a good idea to do this every year during open enrollment since your current plan may have changed or other plans may be offering superior coverage. Verywell Health offers more information on Medicare enrollment periods.
Be Aware of Scams
Unfortunately, scammers take advantage of the Medicare open enrollment period. Ignore calls from people saying they’re “official Medicare agents” unless you’ve asked an agent to call you. Scammers usually threaten that you will lose your Medicare benefits if you don’t sign up for a Medicare Part D plan, but this is not true. Also, people may call to say you’re owed a refund and ask for your personal information — Medicare will never ask you for this information over the phone.
Navigating the world of Medicare is no walk in the park, but don’t let this discourage you from learning about your options. Be ready to put some time into researching and assessing your health needs, looking carefully at premiums, coverage, and co-payments for each plan you’re interested in. In the end, Medicare can help you get the care you need to support your health during retirement.
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