Written by guest contributor, Sharon Wagner
If you’re age 65 and living in the United States, you’ve probably considered Medicare for your health insurance needs. Medicare is one of the benefits of being a working taxpayer, and all seniors are eligible if they’ve been employed for at least 10 years (or 40 fiscal quarters) and have contributed part of their earnings to the Medicare system. However, as wonderful as Medicare can be for your medical needs, it can also be a very confusing system to figure out on your own. This guide will provide a look at the Medicare and healthcare plans under the Medicare umbrella so you can decide what’s best for your healthcare needs now and in the future.
How Does Medicare work?
Once you hit 65 (or are a few months away from it), it’s time to enroll in Medicare. Seniors are at greater risk for medical problems, injuries, and diseases, and Medicare is the federal government’s program for providing healthcare insurance to its most vulnerable population. Younger people with disabilities or end-stage renal disease can also qualify for this service. Medicare functions similarly to private health insurance in that you pay a premium (for Part B), deductible, and copays for healthcare.
Medicare comes in four parts: Part A, Part B, Part C, and Part D. Parts A and B typically come as a pair under Original Medicare, and together they cover hospital insurance (A) and medical insurance (B). This includes inpatient hospitalizations, emergency room and urgent care visits, routine doctor appointments, specialists, lab tests, surgeries, preventive care, hospice, and home health care. Part D, meanwhile, is prescription drug coverage for those who need it to treat long-term health conditions, but the plan is purchased separately from Original Medicare. Part C, as referred to as Medicare Advantage, is a separate plan that covers all of the above.
What’s the Difference Between Medicare Advantage and Medigap?
Medigap is a supplemental plan that covers areas that Original Medicare doesn’t. These areas include copays, coinsurance, deductibles, prescription drugs, vision, hearing, and dental care. Medigap supplemental plans are purchased in addition to your Original Medicare.
Medicare Advantage is also known as Part C, and this coverage is offered by a private insurance company in the place of Original Medicare. It offers the same coverage as Medicare, but it’s privately administered through a plan like an HMO or PPO instead of through the government. The way it works is that the private companies are contracted by Medicare to provide coverage to eligible Medicare patients, and they are only allowed to charge the patient the agreed upon amount.
How Do I Enroll?
For seniors turning age 65, the initial enrollment period for Medicare is three months before and after your birthday. The general enrollment period is January 1 through March 31, with coverage beginning July 1. Although the process can be complicated to understand, there’s good news for those who are less internet savvy: Information exists online to simplify the process to sign up for Medicare and Medicare Advantage plans. These online resources can be helpful when you’re piecing together all of the steps that you need to complete during enrollment.
Who Is Medicare Advantage for?
Anyone who needs more comprehensive coverage from one source might want to consider Medicare Advantage plans. Rather than having separate coverage from Original Medicare for Parts A and B and prescription drug coverage for Part D, Medicare Advantage takes care of all of it in one package. Your out-of-pocket expenses would also be limited, whereas out-of-pocket expenses for Medicare have no cap. If you have a medical condition that requires you to see doctors regularly and take prescription medication, then a Medicare Advantage plan might be right for you.
Systems can be difficult to wade through, and when they’re online, it can be even more confusing. That’s why it’s important to know what you’re getting into so you can make the right choice. When it comes to your health, no stone should be left unturned. There’s little in life that matters more than the one body and brain that you’re given.
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