Medicare coverageWhat does Medicare cover? What doesn’t it?
Evaluating all your available Medicare options can be confusing to say the least. They include Parts A (hospital) and B (medical) also known as Original Medicare, private Medicare supplements, Medicare Part D (drug) and Medicare Advantage (Part C), an alternative to Original Medicare (but which still requires you be in Medicare Part A and B).
Is there an easy way to sort through all the options? Let’s look at two main plan components that may help you choose the plan that’s right for you.
Whether you choose Original Medicare or Medicare Advantage, you will likely have to pay premiums, deductibles and out-of-pocket costs. Many people do not pay a premium for Medicare Part A if for example, they paid Medicare taxes while working or if they have End-Stage Renal Disease (ESRD) and meet certain requirements. If you need to buy Part A, the premium for 2018 is $422 a month.1
In addition to premiums, Part B has a yearly deductible which is $183 for 2018. When you meet the deductible, you typically pay 20% of Medicare approved services.2
Medicare drug coverage, Part D, also has associated premiums, deductibles and copayments or coinsurance. These plans are offered through private companies that are approved by Medicare. Their cost and coverage vary. Be sure to consider if the medications you need are covered and whether your pharmacy is in network to help reduce out-of-pocket costs.3
There are several considerations included under the coverage umbrella. Original Medicare, provided by the federal government, includes Parts A and B, hospital insurance and medical insurance. While doctor visits and preventive services like flu shots are covered, most dental care and vision care is not.4 You can visit any healthcare provider that accepts Medicare.
Medicare Advantage plans, Part C, are offered by Medicare-approved private insurance companies. They include the coverage provided by Parts A and B (except hospice care). They often also provide additional benefits like hearing exams or health and wellness programs.
You usually pay a monthly premium for a Medicare Advantage plan in addition to the monthly Part B premium. You also need to visit the healthcare providers and facilities included in the plan’s network to avoid additional out-of-pocket costs.5
Be sure to understand the impact of any additional coverage you may have. If you’re still covered by your employer for example, make sure you know how your coverage works with Medicare. Your current plan administrator can answer any questions you may have.6
Coverage for prescription drugs is a key consideration. Make sure the plan you choose covers the medications you need under its formulary. You’ll want to understand what your prescriptions will cost under each plan.
You may also want to consider what the plan’s overall star rating is. The star rating provides “an overall rating of the plan’s quality and performance for the types of services each plan offers.” For prescription drug plans that includes customer service, drug safety, accuracy of pricing and member experience.7
If you travel frequently, you will want to understand if and how your plan will cover you away from home in another state or outside of the U.S.
Taking all these factors into consideration can help you choose the coverage that best suits your needs and budget. Keep in mind that your circumstances may change and that you have the ability to change plans during Fall Open Enrollment.8
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