Are you trying to decide what’s the best health coverage for you or a loved one? What if you already have health insurance? The choices can be confusing and overwhelming. To help you better understand your options, here’s what you should know about Medicare plans and other types of insurance so you can get the right coverage to meet your needs.
Original or Traditional Medicare coverage (Part A and Part B)
What’s the difference between Medicare A and B?
- Medicare Part A (Hospital Insurance) covers a hospital stay or care at a hospice or skilled nursing facility, and certain home health care.
- Medicare Part B (Medical Insurance) covers doctor visits, preventive care, medical supplies such as durable medical equipment (DME), and outpatient care.
Unless you have supplemental or Medigap coverage, there’s no maximum on how much you might pay for care each year. If you want prescription drug coverage, you will also need to have a separate Part D prescription plan.
Medicare Part C and D plans are usually offered by private insurance companies.
Medicare Advantage plan (Medicare Part C)
Coverage is provided by an insurance company that has a contract with Medicare to offer Part A and B coverage. They may also cover extra benefits and services, such as vision, hearing, and dental care, for an additional cost.
A Medicare Advantage plan has an annual maximum on how much you pay out of pocket for care. Once you meet this limit, you don’t pay for your care during the rest of the year. Prescription drug coverage is often offered by Medicare Advantage plans. Depending on your plan, you may have to see network doctors.
Medicare Part D (Prescription Drug Coverage)
Part D offers you benefits for medications through insurance companies approved by Medicare. If you don’t sign up for this coverage when you’re first eligible, you may have to pay a late penalty if you get coverage later.
Medicare Supplemental Insurance Plans (Medigap)
Medigap coverage helps to pay some costs that aren’t covered by Original Medicare, such as deductibles, copayments, and coinsurance. To get a Medigap policy, you must have Part A and Part B coverage.
Since Original Medicare and Medicare Advantage plans generally don’t cover care outside the United States, some supplemental insurance companies offer coverage when you travel to other countries.
When can you enroll in Medicare and Medigap plans?
You can enroll in Medicare only during certain times. The Initial Enrollment Period is the first time you can enroll and it usually lasts for seven months starting three months before the month you are 65, the month you turn 65, and the three months after the month you reach 65.
If you don’t enroll during the Initial Enrollment Period, you may end up paying a late enrollment penalty if you want to have Part B later.
The Medigap open enrollment period begins the month you are 65 and enrolled in Part B (Medical Insurance) and lasts for six months. If you don’t buy a Medigap policy during this period, you may not be able to get coverage or it may be more expensive.
What if you already have insurance other than Medicare?
In many cases, individuals turning 65 already have insurance through their employer or their spouse. You can keep your insurance and still enroll in Medicare. For most, Part A is free, while Part B has a monthly premium. If you decide to keep your employer’s health insurance and enroll in Medicare, you must decide which if your employer insurance will be primary and secondary. As your primary insurance, your employer’s insurance will pay first. As a secondary insurance, Medicare will pay first and your employer’s insurance will pick up the unpaid portion.
Want to learn more?
Know what’s covered by Medicare and other insurance:
- Medicare Part A covers hospital visits
- Part B covers medical care
- Medicare Advantage Plans cover extra services such as dental or vision
- Part D covers prescriptions
- If your employer offers insurance, you can keep it and still have Medicare
If you’d like personalized help deciding what insurance you need and how to pay for it, visit The Long Term Living Association or call 1-800-868-1193 to get started today.