This is a question many seniors struggle with from the first time they become eligible for Medicare, and it can continue every year after open enrollment.
Are Medicare Parts A and B sufficient? Should you get a Medicare supplement with or without Part D? Would Parts C and D be better?
Many seniors and other eligible individuals do rely on this program created and sponsored by our federal government to fill their health insurance needs. However, options change every year and new plans may become available. This makes it difficult to know what you really need or what changes you should make to your current plan.
Let’s start by taking a look at each of the parts of Medicare.
Medicare plan types and what they cover
This common term refers to the combination of Medicare Parts A and B offered together.
Part A: Hospital
Medicare Part A covers inpatient care in a hospital, skilled nursing facility, home health care and hospice.
Part B: Outpatient medical
This insurance covers outpatient care and services with doctors and other health care providers. It also provides coverage for labs, x-rays and durable medical equipment like wheelchairs, walkers and hospital beds, as well as other equipment and supplies.
Part C: Medicare Advantage
Medicare Advantage is an all-in-one alternative which bundles benefits under one plan. The plan includes Parts A and B, and can include Part D, prescription drug coverage. It may also offer additional coverage like dental, vision, hearing and over-the-counter medication benefits. Medicare Advantage plans vary in out-of-pocket costs and may require you to use providers within their networks. These plans include HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) options.
Part D: Prescription drug coverage
Often referred to as a PDP, or prescription drug plan, this one assists with the costs of prescription drugs. There are multiple options under Part D with variations in cost and prescriptions covered.
Medicare Supplement Insurance
Also known as Medigap polices, Medicare Supplement Insurance helps fill in the gaps of Original Medicare coverage. These policies currently fall under Plans A, B, D, G, high deductible G, K, L, M and N and help cover costs of coinsurance, deductibles and copayments. For those who were eligible prior to 2020, Plans C, F and high deductible F are also available.
Another type of supplemental policy available in Kansas is a Medicare Select plan. These plans are the same as the previously mentioned Medigap plans, but instead are only accepted at select hospitals within a specific area for non-emergency services.
All Medicare supplements are standardized plans that must follow federal and state laws. This means all plans offer the same benefits no matter which company you enroll under. You may see differences in additional benefits and plan costs, but the supplemental plan itself is exactly the same through every company that offers it.
Step 1: Choose between Original Medicare and Medicare Advantage
Everyone’s situation is different. Because of this and the complexity of Medicare coverage, it truly is best to sit down with an experienced professional and discuss your specific circumstance. A reputable agent will be able to listen to your needs and wants, and then review your options and benefits to help you decide what is the best fit for you and your family.
Here are some very general differentiators between Original Medicare and Medicare Advantage.
Original Medicare may be best for:
- Individuals who want freedom of choice when selecting a doctor, hospital or other provider. One thing to keep in mind is that there are a small number of doctors, hospitals and clinics that do not accept Medicare parts or supplemental plans. It’s always best to check before scheduling an appointment.
- Those who are okay spending a little bit more because they want predictable back-end costs.
Medicare Advantage may be best for:
- People who want the convenience of having the same card for medical and pharmacy since most plans include Part D.
- Individuals seeking additional benefits like dental, vision and hearing coverage. These types of benefits do vary by plan.
Step 2: Decide if you want a prescription drug plan (Part D)
If you opt to go with Original Medicare, you can add on a prescription drug plan. There will be a monthly premium you’ll need to pay in addition to your Original Medicare Part B premium.
Some Medicare Advantage plans already include a prescription drug plan. If not, you may have the option to add it. However, depending on the type of plan you choose, adding a prescription drug plan may not be an option.
If you are already enrolled in a Medicare Advantage plan, it’s best to check with your agent or plan administrator prior to enrolling in Part D or making any changes to your plan as it could lead to loss of your current coverage.
Step 3: Select desired supplemental coverage, if any
There are some healthcare expenses that Original Medicare won’t cover, like copayments, coinsurance and deductibles. Choosing a supplemental policy can help cover some of these costs which would otherwise be out-of-pocket.
Separate Medigap polices can’t be purchased in addition to a Medicare Advantage policy. You’ll want to work with your agent to ensure the Medicare Advantage policy you select encompasses all of your needs for medical coverage.
Step 4: Thoroughly research your options
There are so many caveats to Medicare coverage, that you’ll want to be leery of signing up for a specific Medicare product or supplement without first checking into all your options. Take some time to find a trusted professional who understands all Medicare products and who can provide knowledgeable, unbiased guidance on choosing a policy that is right for you.
Just like a business that is partial to the specific product they offer (understandably), companies that offer only one or two types of Medicare coverage can be partial as well. This is why it’s so important to work with a company that can offer all types and provide you with a comprehensive understanding of how all Medicare pieces could potentially work together for you, or against you.
Contact us to reach an independent agent who can help you navigate the best approach to your Medicare coverage.
Not affiliated with the U.S. government or federal Medicare program.