Medicare Is Confusing, But It Doesn’t Have to Be
By Sharon Wagner (www.seniorfriendly.info)
Twenty-three percent — that’s the number of seniors who stated that reviewing their Medicare plan was the most unpleasant task among choices such as going to the dentist and getting a colonoscopy. Why? Medicare and all its parts and supplements are confusing. Medicare Part A, B, C, D, Medigap — what does it all mean? It’s true that Medicare can feel like a maze, but the following information will help you navigate through it.
First Things First, Original Medicare
If you ever hear someone use the term Original Medicare, they are referring to Medicare Part A and B, which is your basic coverage for doctor and hospital visits. With this plan, Medicare covers an approved amount and you are responsible to pay the rest, often in the form of co-pays after your deductible has been met. You may also be required to pay a premium if you have Part B, but all these terms are explained here in this helpful guide. So, if Original Medicare covers your basic health needs, why do you need supplements? Unfortunately, Part A and B don’t cover prescriptions, long-term care, dental, vision, or hearing.
Part C Is Medicare Advantage
Medicare Advantage plans (Part C) are provided by private insurance companies who are in contract with Medicare, and they cover everything Original Medicare covers in addition to extra benefits. Some of these extra benefits include routine dental, vision, and hearing care, as well as gym memberships. The benefit of a Medicare Advantage plan is that it covers everything Original Medicare does and often touts a lower monthly premium, deductible, and out-of-pocket maximums. However, each state has different coverage and requirements, so use this tool to find information and resources specific to your state.
Part D is for Prescriptions
As we age we tend to need to take more medications, and Medicare Part D can help cover prescription expenses. Keep in mind that while most common medications are covered, each plan varies in the specific drugs it covers. For this reason, it is best to look over the plan’s drug list (also called the formulary) to ensure your medication will be covered. Recently, you may have heard about the Part D donut hole or coverage gap, which results in you paying more out-of-pocket once your total prescription expenses reach a certain amount. Thankfully, recent changes mean the gap is closing, and by 2020, you will only have to pay 25 percent of the cost for covered medications. You don’t reach the coverage gap until your total prescription expenses reach $3,820, and you get out of it once your out-of-pocket spending totals $5,100, at which point you go back to paying your smaller co-pays.
Medigap Explained
Medigap sounds exactly like what it is — it covers the gaps in Medicare. Sold by private insurance companies, it covers certain Part A (hospital, hospice care, etc.) and B coinsurance and copayments, as well as deductibles. It is important to note that Medigap differs from Medicare Advantage in that it is a supplement as opposed to a replacement. However, Medigap offers more flexibility as far as the physicians and facilities you choose to visit, and the costs are often more predictable. You need to be enrolled in Part A and B to be eligible for Medigap, but you can’t be enrolled in Medigap and Medicare Advantage simultaneously.
When Can You Enroll?
Now that you have a better understanding of Medicare and all its parts, what about other important information such as enrollment dates? If you are enrolling in Medicare for the first time, you may enroll three months before your 65th birthday, the month of your birthday, or three months after your birthday. However, coverage will not start until your birthday month if you enroll early. For enrollment specifics, including start dates for Medicare A, B, C, and D, this enrollment guide should provide plenty of information.
There’s no need to sugarcoat it — there’s a lot of information to take in when it comes to Medicare. However, this article should help clear things up. The key is to research, digest the info in pieces, ask questions, and, most importantly, relax.
