Dealing with health insurance is complicated no matter your age, but it’s especially difficult as you get older. Seniors need to make sure they have enough health coverage to meet their needs. But that can be tricky when you’re trying to decide which Medicare plans can cover your conditions, doctors, and prescriptions.
Every senior should ensure they’re getting the best – and most – heath coverage available for their needs. Yet when choosing a Medicare plan is both difficult and confusing, how can you decide what’s really the best?
Michail Petrov / ShutterstockAsk yourself the following questions when you’re signing up for or making adjustments to your Medicare coverage to make the process easier.
Are You Eligible for Medicare?
In most cases, Medicare coverage begins automatically when a person turns 65, as long as you paid Medicare taxes for at least ten years. Younger people with certain medical conditions and disabilities also may be eligible and able to apply.
Once you enroll and your Medicare coverage begins, you’ll get the chance to determine which parts you’d like coverage under. Medicare Part A is free for all subscribers, but you have to pay a monthly premium for any other parts, plans, or supplements you choose.
Do You Want Original Medicare or a Medicare Advantage Plan?
The first step in determining your Medicare coverage is deciding which type of plan – or which type of Medicare – you’d like to subscribe to.
When you first enroll in Medicare, or when open enrollment begins in the fall, seniors are able to choose their Medicare coverage. You have two options¹:
Original Medicare: Original Medicare includes Medicare Parts A and B.
Medicare Advantage: Medicare Advantage plans are alternatives to Original Medicare. These plans are offered by private insurance companies and include the same coverage as Original Medicare’s Parts A and B, as well as other benefits.
There are quite a few differences between Original Medicare and Medicare Advantage plans.
Original Medicare allows you to see any doctor or hospital that accepts Medicare across the United States. It does not include prescription drug coverage², so seniors often add Medicare Part D (the Medicare prescription drug plan) to their coverage. Seniors also are responsible for out-of-pocket expenses of around 20 percent on Original Medicare, which means many subscribers also buy supplemental coverage like a Medigap policy³.
A Medicare Advantage plan is more of an “all in one” health insurance plan. An alternative to Original Medicare, Medicare.gov⁴ describes the Medicare Advantage plans as “bundled plans [that] include Part A, Part B, and usually Part D.” Additionally, Medicare Advantage plans can include coverage that Original Medicare does not – like dental, vision, hearing, and more⁵.
Do You Want Prescription Drug Coverage?
Once you’ve decided whether Original Medicare or a Medicare Advantage plan is best for you, you’ll want to assess your prescription drug needs.
Ask yourself if you need prescription drug coverage. Do you pay a lot of money out of pocket for your medications? Do you need a health insurance plan that covers certain expensive medications? Are there certain medications that you rely on that must be covered?
If you don’t need prescription drug coverage, you’re all set. Original Medicare doesn’t include prescription drug coverage, and many Medicare Advantage plans do include it.
However, if you do need prescription drug coverage, you’ll want to consider other options. If you’re interested in Original Medicare, you’ll need to choose a Medicare Part D plan. Medicare Part D offers prescription drug coverage for a monthly premium⁶.
If you’re interested in Medicare Advantage, check to see if the plans you’re considering include the prescription coverage you need. You can compare different plans and choose one that suits your medications and budget.
Do You Need Supplemental Coverage?
Supplemental coverage is another important factor to consider when you’re on Medicare. Because Medicare coverage often has many gaps and high out-of-pocket expenses, seniors often choose to add supplemental coverage. A supplemental plan can help reduce costs, increase their coverage, and have more flexibility in their health insurance.
Supplemental coverage, which is often called Medigap, is intended to fill the gaps Medicare leaves in its coverage. And any Medicare subscriber can get a Medigap plan. These plans are available from private insurance companies, and they can cover important – and costly – aspects of healthcare, like coinsurance, copayments, and deductibles⁷.
Medicare Plan F has been one of the most popular supplemental Medigap plans. However, in 2020, a big change is coming. Plan F won’t be available.
Anyone who’s eligible for Medicare on January 1, 2020 or at a later date will not be able to choose Plan F for supplemental coverage. Instead, you’ll have a new option: Plan G.
Fortunately, Plan G will cover even more than Plan F currently covers. It offers broad coverage for many common out-of-pocket costs. Plan G will cover nursing facility care, foreign travel emergency coverage, and the coinsurance or copayments for many Medicare Part A and B services⁸.
And if you don’t want to get stuck paying for expensive medical procedures, doctor’s visits, and other expenses, supplemental coverage is a smart choice. It offers financial peace of mind, and it can cover absolutely everything Medicare fails to.
Consider Your Medicare Options Now to Make the Best Decision
If you’re an older adult who’s wondering what Medicare plans, parts, or options offer the health insurance coverage you need, you aren’t alone. The process of choosing and creating your plan – and updating or changing it yearly – can be confusing and complicated. But fortunately, if you ask yourself the questions mentioned here, you can make it much easier.
And knowing what options are available is important. You should make sure to do thorough research when considering Medicare plans. Compare different plans, such as Medicare Advantage plans, to one another. And don’t forget to assess different Medicare parts, like Part G, that you may be able to take advantage of.
Taking the time to do your research can also save you money. The only way to find the lowest Medicare rates and cheapest health insurance options is to search for and compare all of the available plans.
