Medicare Coverage Options

If you're considering Medicare plans that may be available, take a minute to learn more about the options. The best time to do this is when you first apply for Medicare, and your agent or enrollment specialist will fill out a form for you. Most people start with Original Medicare or its reduced-cost alternative, Medicare Supplement Insurance, known as Medigap. You may also qualify for prescription drug coverage under the Medicare Advantage Plan. Once you have selected the plan that best suits your needs, this section will help you determine the essential features. Generally speaking, Advantage plans are better valued than Original Medicare because they are less expensive and cover more benefits. With Original Medicare, you have to pay for some services covered by Advantage plans. Since there are so many options, the only way to understand if a plan is right for you depends on your current health condition and the health conditions you expect in your future.

1. Original Medicare

Including both Hospital Insurance and Medical Insurance, this is the original program created by Medicare (Parts A and B) in 1968. You get it if you are eligible for Social Security benefits or disabled and qualify for Social Security Disability benefits. With Original Medicare, you can choose your doctor without restrictions, but you must pay for all Part B services yourself. You'll usually pay a monthly premium for Part A and a yearly deductible before Part b kicks in. Another outstanding feature is the coverage of long-term care services, reducing out-of-pocket costs for some services. Suppose you or a family member need nursing home care. In that case, your Medicare will pay for services provided by skilled nursing facilities but not for custodial care such as housekeeping and light cooking. Some Medicare Advantage plans cover custodial care. With Original Medicare, you can choose a provider who accepts Part A and B ("Physician") or one who accepts Part A only ("General Practitioner"). Some doctors will see patients with Part A and B, while others may see only Medicare Part A patients. When you choose a doctor, and later when you need to change doctors, it is essential to ask if they accept Medicare and what kind of insurance they accept. If your doctor doesn't accept Medicare, you can pay your bills out-of-pocket, or if your doctor is not near your home, you can join an organization called "Access Health CT," which will find a provider close to where you live.

2. Medicare Advantage (also known as Part C)

Medicare Advantage is offered by a private health insurer, usually a health maintenance organization (HMO). They also include some Part A and Part B benefits that traditional Medicare doesn't cover. Private insurance carriers offer Medicare Advantage plans, and they compete nationally. Medicare Advantage plans are not regulated by the Centers for Medicare & Medicaid Services (CMS), and the Federal Government provides no oversight. CMS must approve your plan before it can sell in your area, but once approved, you have no real recourse when problems arise. You can access the Health Insurance Marketplace and compare plans offered in your area. Once you find a plan that appeals to you, your agent or enrollment specialist will guide you through enrolling by completing an application form. Also known as a Medicare Advantage Plan, these are private insurance plans available under Medicare regulations; they are purchased by individuals who want more services than Original Medicare provides. They include Medicare parts A & B, vision, hearing, and dental coverage (the advantage). You purchase Medicare Advantage on the websites Like Clearmatch Mediсare or Ehealth.

What to Consider when choosing Medicare Coverage Option

Choosing a Medicare coverage option involves more than just price. The right Medicare plan for you will depend on your health condition and the costs associated with that insurance. To help you, we've included some questions you can ask during the enrollment process to help determine which plans will best fit your needs.

1. How well does the plan cover the services you need?

What services are covered by the plan? Does it cover all of the services you'll need every year? Will you have to pay an additional amount for some services not covered by your Medicare plan? Some plans provide coverage abroad at a reduced rate. If you want to be insured in case of an extended stay outside of the U.S., check out a Medicare Supplement Plan (MP), which will pay for these charges if the U.S. plan does not cover them.

2. Prescription Drugs

If you need a Medicare Prescription Drug Plan, also known as Part D, go here to learn more. Understanding the different options and costs associated with each is essential to this process. Part D is voluntary; you have to choose from plans offered by private insurance carriers, and competition between these carriers is intense.

3. Doctors and Hospital Choice

Several Medicare plans allow you to choose your doctor. Some Medicare plan options will enable you to go outside of their network if the doctor you want is not in their plan's network. Plans have different networks, which dictate who their doctors and hospitals are; some have very little choice. There is a list of the Medicare physicians approved by your medical insurance company on the CMS website.

4. Quality of care

Ask your friends, relatives, and neighbors about their experiences with the plans that you are considering. Find out what kind of services they receive and how satisfied they are with the care. The Centers for Medicare & Medicaid Services (CMS) provides a Medicare Plan Finder that allows you to search for all Part C and Part D plans in your area. Choosing the right Medicare coverage option is an important decision. Throughout the process, remember to ask for more information about the plan, such as copayments, deductibles, and annual and lifetime maximums. Medicare plans have restrictions, and it's essential to understand what they are and how they pertain to your situation. We've compiled this handy table that outlines the significant differences between Medicare Advantage and traditional Medicare, as well as several variations.