5 Important Enrollment Periods You Should Know
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There are so many Medicare options available to people that it can be extremely difficult to decipher the information being presented by the Medicare website or other informational sites that go into great detail about all of the options. So, we decided to put together a quick reference guide for you to be able to make sense of some of the main points quickly.
Find below some Medicare comparisons, how coverage works, how expenses are treated, and how to select the right Medicare option for you!
1 – Your First Option: Original Medicare
Original Medicare (or Traditional Medicare) is an option that offers Part A (hospital insurance) and Part B (medical insurance) services.
2 – The Pros of Original Medicare
Medicare is accepted by the majority of hospitals and doctors in the U.S. (as long as they do accept reimbursement for covered services at a Medicare-approved amount). Under Original Medicare, you may select your own doctor from a large network.
3 – Cons of Original Medicare
Original Medicare includes deductibles, copays, and coinsurance for medical services without an annual cap on costs to the senior. Beyond the potentially high cost, Original Medicare fails to provide prescription drug coverage.
4 – Your Second Option: Enrolling in A Medicare Advantage Plan
You could potentially choose a Medicare Advantage Plan instead of Original Medicare. These plans usually vary in their services, and health coverage is given by a private company approved by Medicare.
5 – Pros of a Medicare Advantage Plan
Medicare Advantage Plans cover all benefits Original Medicare does and can also provide coverage for certain services not included from Original Medicare (like vision, dental, hearing aids and more). Medicare Advantage plans can significantly reduce copays & coinsurance for medical services and have a maximum out-of-pocket (MOOP) on covered expenses beneficiaries may pay in any given year. The majority of plans include prescription drug coverage, but various plans may require you to purchase this separately as Part D Medicare (see number 7).
6 – Cons of a Medicare Advantage Plan
Medicare Advantage Plans frequently limit the medical providers you may see for covered services. Location can be a downside as well since MA plans are typically more available in urban areas.
7 – Part D: Prescription Drug Coverage
Part D is Medicare prescription drug coverage that can be purchased separately as a Stand-Alone Prescription Drug Plan, or bundled in a Medicare Advantage Plan. Similar to Medicare Advantage Plans, Part D is run by private companies that are approved by Medicare and follow the rules set by Medicare. Be sure you understand the Part D plan and all of the nuances to avoid the Part D penalty. Call us anytime, for free, at (888) 352-6672 to discuss your Part D situation in more detail if you would like some help.
8 – Medicare Supplement Policies (Medigap Policies)
Medicare Supplement Insurance or Medigap policies are offered by private companies and helps to pay some of the health care expenses that Original Medicare doesn’t cover, including copayments, coinsurance, and deductibles. Some Medigap policies can also offer coverage for services that Original Medicare doesn’t help with, such as medical care when you travel outside the U.S. Medigap policy plans are standardized but they do depend on where you live.
9 – Premiums
There’s a monthly premium for Medicare Part B that is adjusted annually by Medicare and has to be paid by all beneficiaries who enroll in either Original Medicare, a Medicare Advantage Plan, or a Medicare Supplement Plan. All Stand-Alone Prescription Drug Plans and Medicare Supplement Insurance Plans come with a monthly premium that varies by plan and location. Medicare Advantage Plans can have an additional monthly premium but some are offered as low as zero dollars depending on the exact plan and location.
10 – How to Pick the Best Medicare Option
The absolute best way to choose the right Medicare plan is to assess your current health and budget, project services you think you may need in the future, and decide on a plan that effectively ties everything together with a reasonable price. It’s important to compare the out-of-pocket costs you will incur, such as deductibles, coinsurance and copayments. Although unattractive at first glance, higher premiums can mean lower out-of-pocket expenses. Looking for a Medicare option that’s perfect for you? Our team can show you an array of Medicare plans that can work for your unique situation.
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.