By Cathy Aquino, Director of Government Sales, Independent Health
Everybody likes having choices. But, sometimes too many choices can be overwhelming. That’s why making decisions about health coverage can be pretty daunting. Since many people have had the same type of commercial insurance through their employers for years, it’s natural for people to feel confused in figuring out their options once they’re eligible for Medicare.
Most people obtain Medicare once they turn age 65. However, there are other reasons that make people eligible at a younger age, such as having a qualifying disability or experience another situation.
For those who are approaching the magic age of 65, here’s a quick primer about Medicare.
First, before making any decisions about Medicare coverage, look at your current health care coverage. If you’re covered through an employer or union, check to see if you are able to continue that coverage or if it’s better to opt out of that coverage and select a Medicare plan.
Once you know you need Medicare coverage, you have two Medicare options: Original Medicare, which consists of two parts, A and B, or Medicare Advantage (also known as Part C). More on the types of Medicare coverage later.
Within these two options, you have many choices: prescription drug coverage (Part D), supplemental coverage and more. To decide which is right for you, you’ll need to do some homework.
Timing is important. You can sign up for Original Medicare or a Medicare Advantage plan as early as three months before you turn age 65. To enroll in Original Medicare, contact your local Social Security Office.
Medicare doesn’t cover everything. You may have copays, coinsurance, deductibles and other payments whether you choose a Medicare Advantage plan or Original Medicare.
Like your commercial coverage, your plan choices are not permanent. You’ll be able to change plans as of January 1 each year. (There are exceptions known as “special election periods” but these are based on eligibility).
Types of Medicare Coverage
Basically, there are two types of Medicare: Original Medicare and Medicare Advantage. Within those two general categories are a variety of other options, benefit levels and costs.
This is the coverage offered directly through the Federal Government, available at no cost to people who have worked, or whose spouse has worked, for at least 10 years and have paid Medicare taxes through their employer.
Part A has no monthly premium. It covers inpatient hospital stays, skilled nursing facilities, hospice, and some other skilled care.
Part B covers care received in doctors’ offices, outpatient care, as well as other medical services, like preventive care, that Medicare Part A doesn’t cover. There is a monthly cost based on your income.
This is known as Part C. These are private health plans that usually cover more services and have lower out-of-pocket costs than Original Medicare. Every insurance company that offers these plans has a contract with the Federal government that is renewed annually.
If you join a Medicare Advantage plan, it will be responsible for paying your claims. You will be responsible for other plan costs (copays, coinsurances, etc.). You may also have a monthly premium, depending on the plan you choose.
Some Medicare Advantage plans include drug coverage, which is known as Part D. Choosing whether or not you need prescription coverage when you join a Medicare Advantage plan at age 65 is up to your needs. And, you can add or change your Part D coverage once a year at the same time as your other Medicare choices.
Medicare Supplemental Policies
These policies are also known as “Medigap” plans. They cover some or all of the expenses not covered by Parts A and B. People who choose Original Medicare may want to have a Medigap policy, which has a premium based on the plan selected.
Each of these options has pros, cons, varying costs, and coverage, so if you’re getting close to age 65, it’s a good idea to begin researching your options sooner than later.
Check out this free guide from Independent Health, The RedShirt’s Guide to Medicare. It covers everything you need to know about your Medicare options, including detailed descriptions of the different types of coverage, eligibility, plan definitions and more.
Also, check out WNYMedicare.com for additional information, including short videos to help you become better acquainted with the types of choices that will be available to you. You may also e-mail firstname.lastname@example.org.