Choosing the right Medicare plan can be daunting, considering all the options out there. Making the wrong choice and having to live with it for a year is not something people want to do. The following information has been taken from the Medicare.Gov website to help you choose the right plan for your situation.
Coverage
Let’s first compare the insurance coverage you will receive from Medicare Plans A & B vs Medicare Advantage Plans. Each has many options, and this comparison is only used as a general overlook.
Original Medicare covers most medically necessary services and supplies in hospitals, doctors’ offices, and other healthcare facilities. Medicare Parts A & B don’t cover some benefits like eye exams, most dental care, and routine exams.
Medicare Advantage Plans cover all medically necessary services that Medicare A & B covers. Plans sometimes offer some extra benefits that Original Medicare doesn’t cover – like vision, hearing, and dental services.
For original Medicare, you must join a Medicare Drug Plan D to secure help with medication costs. Medicare Advantage plans already have drug coverage included.
The big difference in Medicare coverage compared to Medicare Advantage Plans is that, in most cases, you don’t have to get a service or supply approved ahead of time for Original Medicare to cover it. Medicare Advantage Plans will need prior approval and will limit where you obtain benefits.
Choice
Speaking of where you can get services, the next big difference between Medicare Part A & B as compared to Medicare Advantage Plans is that with original Medicare, you can go to any doctor or hospital that takes Medicare anywhere in the U.S. But with Medicare Advantage Plans, you must stay within their network of approved facilities (for non-emergency care), or you may have to pay additional fees.
Costs
The plan you ultimately choose will most likely be linked to how much it costs. Let’s look at the Medicare Advantage Plans. You pay the monthly Medicare Part B premium that you would with original Medicare and may also have to pay the plan’s premium. Some plans may have a $0 premium and help pay all or part of your Part B premium. Most plans include Medicare drug coverage (Part D). Advantage Plans have a yearly limit on what you pay out of pocket for services Medicare Part A and B cover. Once you reach your plan’s limit, you’ll pay nothing for services Part A and Part B covers for the rest of the year. Out-of-pocket costs vary for Medicare Advantage Plans; some plans may have lower or higher out-of-pocket costs for certain services. Looking at which services you may use or do use consistently and matching the plan is very important here.
Costs for Medicare Part A & B can be summarized as follows: You pay a premium (monthly payment) for Part B. If you choose to join a Medicare drug plan, you’ll pay a separate premium for your Medicare drug coverage (Part D). For Part B-covered services, you usually pay 20% of the Medicare-approved amount after you meet your deductible. This amount is called your coinsurance. Look here for definitions of basic insurance terms such as deductible or coinsurance. There’s no yearly limit on what you pay out-of-pocket unless you have supplemental coverage – like Medicare Supplement Insurance (Medigap). Medigap should be chosen early because it gets progressively more expensive as you age. Medigap can help pay your remaining out-of-pocket costs (like your 20% coinsurance). Or, you can use coverage from a former employer or union, or Medicaid.
This hopefully makes your decision much easier when comparing different plans. If you want more information on choosing the right plan, look at the government’s website for their handy decision guide.
