Medicare Basics
Medicare is a single-payer, federal health insurance program available to anyone who is at least 65 years old, as well as some younger people who have certain illnesses or disabilities. Medicare coverage is divided into three parts:
- Part A – Hospital Insurance: Primarily covers care in hospitals and skilled nursing facilities
- Part B – Medical Insurance: Generally covers doctor visits, checkups and some medical equipment
- Part D – Drug Insurance: Helps cover prescription drug costs
Medicare Advantage plans, which typically encompass hospital, medical and drug coverage, are often referred to as “Part C” plans.
Like private health insurance, Medicare plans have deductibles, copays and monthly premiums. Comparing these costs is a major factor in selecting the best plan for your needs.
How To Choose the Best Medicare Plan for You
There are many Medicare plans available, so it’s key to understand the differences and figure out which best suits your needs. Navigating the various plan types and enrollment procedures can be tricky. Follow these steps to select and sign up for your ideal Medicare coverage.
1. Determine Your Enrollment Period
There are two primary Medicare enrollment periods to consider. The first is your initial enrollment period, which includes the month of your 65th birthday, the three months before your birth month and the three months after your birth month. You can enroll for any or all of the Medicare components during this seven-month timeframe.
After your initial enrollment period, there is also an open enrollment period each year, which is typically from mid-October through early December for original Medicare, and from January through March each year for Medicare Advantage plans. During open enrollment, you can add or remove coverage or switch Medicare plans to ensure your coverage is the best Medicare plan for you. Special enrollment periods may apply to people in certain circumstances.
2. Enroll in Medicare Parts A and B
Some people — usually those who already receive Social Security benefits — are automatically enrolled in Medicare Parts A and B. If you aren’t automatically enrolled, then your next step is to sign up. You can join during either your initial enrollment period or open enrollment.
Regardless of whether you decide to keep your Parts A and B coverage or switch to a Medicare Advantage plan, you must first sign up for Parts A and B and receive your Medicare number and other enrollment information. You also need to be enrolled in Part A, Part B or both to join a Medicare Part D drug plan.
3. Choose Between Original Medicare or Medicare Advantage
After you have enrolled in Medicare Parts A and B, you have the option to keep this coverage, collectively known as “Original Medicare,” or switch to a Medicare Advantage plan. Here are some of the key differences between the two options so you can choose your best Medicare plan.
Original Medicare
Original Medicare covers most necessary medical treatment and equipment. You can visit nearly any doctor or hospital, and you usually don’t need a referral to see a specialist. You pay fixed monthly premiums and predetermined copayments. There are no out-of-pocket limits, though you may purchase a Medigap policy to help cover these costs.
Original Medicare doesn’t include drug coverage; instead, you choose a separate Medicare Part D drug plan. This makes Original Medicare highly customizable, so you avoid paying for coverage you don’t need.
Medicare Advantage
Medicare Advantage plans are Medicare-compliant insurance plans administered by private insurance companies. These plans bundle Medicare Parts A and B, along with prescription coverage, into a single policy, which makes them more convenient but less customizable than Original Medicare plans. You must typically use only in-network providers, and you may need referrals or prior authorizations.
Advantage often includes coverage for things that are not covered by Original Medicare, such as dental or vision treatment. With these plans, you pay ordinary Part B premiums plus the private insurance cost. There is usually a yearly limit on your out-of-pocket costs. Medigap coverage is not available.
4. Compare Options To Find Your Best Medicare Plan
You can view the details of most of the Original Medicare and Medicare Advantage plans available in your area on Medicare’s website. For any plan, check to see what’s covered and what your costs will be, including premiums, deductibles, copays, and prescription costs. Also, verify that your current doctors and medications are covered. If you choose a Medicare Advantage plan, find out what happens if you use an out-of-network doctor or pharmacy.
5. Select Your Drug Coverage (Medicare Part D)
Most Medicare Advantage plans include prescription drug coverage, but if you choose Original Medicare, you may want to add a Medicare Part D prescription plan. You aren’t required to have a Part D plan. Review the options available where you live to ensure that your prescriptions are covered. Check to see whether you are required to use a preferred pharmacy and whether the plan requires any prior authorizations or other coverage restrictions.
Get Help Choosing a Medicare Plan
If the array of choices feels intimidating, you don’t have to go it alone. At Emerald Insurance Group, you can consult with an experienced, independent insurance agent who can help you select the best Medicare plan for you. An independent agent can answer any questions, help you compare plans and even assist you with the sign-up process, all at no cost to you. Contact us today to learn more and get started.
Sources:
https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/what-does-medicare-cost
https://emeraldinsurancegroup.com/enrollment-periods/
https://emeraldinsurancegroup.com/contact-us/
