Having questions about what the right kind of Medicare coverage is for you? You are not alone. Everyday there are roughly 10,000 people in the U.S. alone who turn 65, and they all have to wrestle with the same question.
It’s a difficult landscape to navigate. There are countless television commercials and 800 numbers to dial. You’ve undoubtedly been assaulted by 30, 40 or even 50+ pieces of direct mail coming in from all parts of the country. Medigap this, part D that, Medicare Advantage… It’s enough to make you want to scream. All the while, no one is really taking the time to empower you with the necessary information in order to make an informed decision. They just want your enrollment.
At Medicare Information Project, we do things differently. Our primary focus is to build trust with you. Our mission is to make Medicare easy for you to understand, and our objective is to make you like us so much you won’t want to do business with anyone else. We want to be your agent for life!
So what is the right Medicare plan? There’s a lot to consider before we can help you answer that. Rather than try to do that fully in this article, what I will outline below is a mile high view of the different options available to you. Ultimately, factors such as your doctors, medications, location, health conditions, desire for flexibility etc. will all play a vital role in determining what is the right coverage.
That said, here are the main options for you to consider:
Option 1: Original Medicare
When we talk about original Medicare, it refers to Medicare Part A and Part B. In a nutshell, Medicare Part A is your hospital coverage, and Part B covers your primary/specialist doctors and outpatient procedures. Part A is generally free, so long as you’ve worked at least 40 quarters in the U.S. Part B, on the other hand, does have a premium associated with it. At the time of this writing, the Medicare Part B premium for most people is $170.10 (premiums can be higher based on income). Aside from this premium, there are deductibles that must be met for both Parts A/B and there are still services that you will be required to pay a 20% coinsurance on. The main benefit to original Medicare is the fact that you can go see any doctor that accepts Medicare – no network, no referrals. The biggest drawback to sticking with original Medicare, is that there is ZERO protection for you in terms of capping how much you could be required to pay in a given year for medical treatment. We refer to this cap as, out of pocket maximum. This leads us to our second option.
Option 2: Original Medicare with a supplement (Medigap)
To help mitigate the risk of not having an out of pocket maximum, and still having the benefit of seeing just about any doctor you’d like, you have the option to add a supplement plan to original Medicare.This option is arguably the most comprehensive, but it is also the most expensive up front. Depending on when you turned 65 there are anywhere between 8-10 different types of Medigap plans. Each of them vary in terms of monthly premium (in addition to your part B premium), and how much they will pay towards the 20% you’re responsible for under original Medicare. Medigap plans for a 65 year old will range anywhere between $180 – $220 per month, in addition to your part B premium. Disclaimer: This is a very stripped down explanation of this coverage, just trying to provide some insight as to how this coverage works alongside Medicare.
***As a side note, neither option 1 or 2 come with any sort of prescription drug coverage. With either of these options you will need to purchase a separate drug card referred to as Pard D. Drug cards can range anywhere from $5 to around $100 depending on the types of medications you need to have coverage for.
Option 3: Part C – Medicare Advantage or MAPD (Medicare Advantage w/Prescription Drug)
Medicare Part C is the type of coverage you will hear about the most. The best way to explain this coverage is that it acts as a “replacement” to Original Medicare. Part C is offered through private insurance carriers that take on the liability of its members in place of the government via Original Medicare. Medicare Advantage plans work very much like the type of coverage you’re used to through an employer. These plans come in two main types: HMO and PPO, as well as a few other less popular options. Although you may lose some of the flexibility of straight Medicare, because you now have to deal with networks, you more than make up for it in how feature rich MAPD plans can be. Most MAPD plans come with drug coverage included, so there’s no additional fee for your part D drug card. Even better news is that the majority of these plans are available with no additional premium. At minimum, these plans must offer coverage as good as original Medicare. What you will often find though, is that these plans come with some added benefits that make them highly attractive, such as: maximum out of pocket limits, standard co-payments, ancillary benefits like vision and dental, and perks like OTC credits and fitness memberships.
Now that you have a more clear understanding of your options, we would love to schedule some time to speak with you. In doing so, we can gain a better understanding of what you’re looking to get out of your health coverage and help you narrow down the selection of plans to what best fits your needs.
Medicare Information Project