Do you understand all of the ins and outs of Medicare? If you’re anything like most adults age 65 and older who are either preparing to enroll in Medicare or already enrolled, you probably don’t. Medicare can be complicated, and knowing what’s covered and what isn’t can be confusing at times. You need to know what’s included in your health insurance if you’re on Medicare, and the best way to stay informed is to search for the latest information online.
From Original Medicare to Medigap to Medicare Advantage, there are a lot of moving parts involved in choosing your Medicare coverage. And you have a lot of options to consider and compare. Search online to find Medicare plans and coverage that’ll meet your needs.
Before you enroll in Medicare for the first time or make changes to your coverage during open enrollment, make sure to consider the following important factors.
Your Coverage
First and foremost, you’ll want to consider the type of coverage you need. You should assess how well your current plan – or the plan you’re interested in – will cover the healthcare services you need.
Within Medicare, there are two primary plan choices: Original Medicare and Medicare Advantage. Original Medicare, which includes Part A and Part B, covers most medical services and supplies when you visit a hospital, doctor’s office, or other healthcare setting. Medicare Advantage covers all of the same services as Original Medicare, and it may cover additional benefits too.
It’s also a good idea to consider any other coverage you might have, like an employer-sponsored health insurance plan or prescription drug coverage. Do these plans work with Medicare? Do they have limitations that don’t suit your needs?
Take the time to thoroughly assess whether you’ll be covered for the services you need and use the most. You should make sure your normal doctor’s visits as well as any specialized healthcare needs you require are covered.
Whether or Not You Want Supplemental Coverage
If you find that basic Medicare coverage isn’t enough for your needs, you’ll want to think about supplemental coverage. Supplemental coverage is available in the form of Medicare Supplement Insurance, or Medigap.
Medigap plans are sold by private health insurance companies, and they’re meant to help fill gaps that Medicare coverage can cause. They may be able to pay for some of your additional healthcare costs, like copayments and coinsurance, that Medicare doesn’t cover on its own. Additionally, some Medigap plans will even cover services that Original Medicare does not. For example, you may be able to find a Medigap policy that covers international travel.
Look into what Medigap covers to determine if it’s a good fit for your needs. You can also consider whether Medigap will completely fill your healthcare and cost needs, or if you might need to change to a Medicare Advantage plan.
Prescription Drug Coverage
Another coverage area that’s often lacking under Medicare is prescription drug coverage. Many people automatically assume that prescription medications are covered like they are with private health insurance policies. However, Medicare actually does not cover all prescription drugs, and there are limitations to the costs and requirements for out-of-pocket spending.
You should look into the details of Medicare’s prescription drug coverage. Determine if your medications and their costs will be covered. Will you potentially need to join a coverage plan later on? Will the cost of your prescriptions increase? Are there limitations?
If you need a prescription-specific policy, you have two options. Original Medicare subscribers can join a Medicare Prescription Drug Plan (also known as Part D) to get coverage. Medicare Advantage subscribers can choose a policy that offers and includes prescription drug coverage.
Your Doctors and Local Hospitals
In addition to thinking about your health needs and your medications, you’ll also want to consider your doctors and local hospitals. Like all other health insurance policies, Medicare does impose special limitations on which doctors and hospitals you can see.
Original Medicare subscribers can only see doctors and hospitals that accept Medicare. Medicare Advantage subscribers do have more flexibility, but you’ll need to check your plan’s coverage to determine whether you have limitations. Some plans require you to see only doctors and hospitals that are within the plan network. Others will allow you to see out-of-network providers at a different cost.
Consider whether your doctors and any specialists you see regularly accept Medicare. Do you need to switch doctors? Do you want to switch doctors? Can you visit the local hospital, or is it out of network? You’ll want to look into all of these factors before settling on a final plan.
Your Costs
Lastly – and perhaps most importantly of all – you’ll want to consider how much your Medicare coverage will cost.
Consider cost-related factors like the following:
- How much will your monthly premium be?
- Do you have an annual deductible?
- What copayments will you be responsible for?
- How much will visits to specialists cost?
- Are there restrictions on what your plan will pay for?
Under Original Medicare, you won’t have to pay a premium. However, there’s no limit on how much you’ll pay out-of-pocket, unless you opt for supplemental coverage. Medicare Advantage plans can come with $0 premiums too, and many have limits on your annual out-of-pocket expenses. But keep in mind that you may be responsible for other costs.
To manage cost and coverage when you’re enrolling in Medicare or updating your plan, make sure to search online. Compare different plans and different types of coverage. Consider all of the important factors mentioned here. That’s how you can be prepared and make an informed decision on which Medicare options are the right choice for you.