Many people, when turning 65, retiring, or going on Medicare Disability don’t have a clear understanding of Medicare and how it works. Therefore, making a mistake choosing the proper plan for YOU and YOUR needs is highly likely.
First, we will begin by deciphering each part of Medicare.
Part A: This is the HOSPITAL coverage. There is NO premium for Part A. This portion of Medicare covers the hospital, such as the Emergency Room, Operating Room, or Patient Room. With original Medicare Part A coverage, you can choose any hospital in the USA.
Part B: This is Physician Services coverage. There IS a premium for Part B and it is based on your income. Physician services encompass doctor visits, surgery, labs, any diagnostic tests, durable medical equipment, home health services, etc. For the most part, Medicare pays approximately 80% for many of these services once the deductibles are met. With original Medicare Part B coverage, you have the freedom to see any doctor in the United States that accepts Medicare. There are no networks, no referrals, no authorizations. YOU, as the patient, are in the driver’s seat.
Part C: These are your Advantage Plans A.K.A. Medicare Replacement Plans. These are your HMO, PPO, and Fee for Service Plans that are run through a private health insurance company. These plans encompass the coverage of parts A & B. Many will also cover Part D prescription drugs. Some of these plans have little or no additional premium outside the Part B premium. What you MUST understand about these plans is that they REPLACE Medicare. When your Part B premium is sent to Medicare, Medicare then sends it to the private insurance company you chose. THEY are now in charge of your care. That is why they call it managed care. An insurance company is in control and determines who you can see via the network of providers, which hospitals you can go to, which lab you must utilize, etc. Many times, these plans are area, region, and/or state specific. This means that if you travel outside of your plan’s service area, you may not be covered unless it is a life-threatening emergency.
Part D: Prescription Drug Coverage. You can obtain prescription drug coverage through a stand-alone prescription drug plan or through a Medicare Advantage Plan. Prescription drug coverage should be reviewed annually as the plans change as do your prescription drugs.
Medicare plan options are NOT a one size fits all. You should NOT select a plan based off a friend, aunt, cousin, neighbor, etc. This is an individual decision based on individual need. Working with an independent agent, who has the ability to offer multiple plan options, including Advantage Plans AND Supplement Plans is always the best bet.
By Julie Biederman
Medicare Questions? Call 954-243-1483