Health insurance can be one of the most confusing aspects of being an adult. As we get older, access to medical care gets more and more important, which is exactly why Medicare is such a vital program in the United States.
Medicare covers American individuals who are 65 years or older, and some younger people with certain disabilities.
Currently, there are almost 60 Million citizens insured by the government-funded Medicare, with some sections distributed by independent companies, similar to a private health insurance plan.
If you’re over 65 or have a qualifying disability, you may be wondering which Medicare plan is best for you. Let’s explore the three variables that may affect your decision.
1. Your Medical Goals
Your decision on a health insurance plan, whether it is private or through Medicare, should be based on your medical goals as an individual. Medicare has four divisions which offer different coverage and benefits.
Part A is the original plan which covers general hospital costs, such as a hospital room, board, and general procedures, but does not cover prescription drugs.
Part B fills in the gaps of part A by providing coverage for more extensive testing, outpatient care, and most hospital procedures. Part A is the basic package, while Part B is an add-on if you need more coverage.
Part C falls under a category known as Medicare Advantage. If a Medicare user is also covered by a group plan, such as a company plan or private health insurer, they will likely have add-ons included such as dental, vision, and prescription coverage.
However, if the user is completely reliant on Medicare, they will likely need to enroll in either Part D of Medicare or Medicare Advantage.
Medicare Advantage plans are offered by independent health insurance companies and act as a replacement for Parts A and B. They offer the same coverage as the original Medicare plan, but with additional pieces included such as dental, vision, hearing, and prescription drug coverage.
If you’d like to learn more about the difference between the plans and what they cover, Health has a great guide on the best Medicare Advantage plans on the market right now.
2. Your Medical Conditions
Once you’ve figured out the level of coverage that is necessary for your health goals, you should also consider the medical conditions that you already have which will need to be covered under Medicare.
As mentioned earlier, the original Medicare plan only covers hospital stays and general medical procedures, so if you have a condition that requires more extensive care, you will need to check what other options are available to you.
For example, if you have a recurring issue with your eyes, like glaucoma, you would want to enroll in a program that would cover your vision costs, at least partially. Review all of your conditions and make sure that the plan you are choosing offers adequate coverage for your type of health concerns.
3. Your Budget
Even with health insurance, you will still be required to pay for some of your health care costs. Part A does not usually require a premium payment, although there is a deductible for the pay period, in addition to a limit on the amount of days you can stay in a hospital with full coverage.
In other words, as you stay longer in a hospital or rehab center, you may have additional co-payments. Part B does require a premium of around $150 a month, with about a $200 deductible. After that deductible is met, you can expect to pay 20% of the Medicare-approved amount for doctor services.
For Medicare Premium and Part D Medicare, the expenses will vary by the plan that you choose. For Medicare Premium, check if the company you are considering offers an HMO, PPO, PFFS, or SNP, depending on the type of care you need and the limit of your budget.
You can check here to learn more about the differences between the four types of Medicare Advantage plans and the costs associated with them.
Choosing a Medicare plan doesn’t have to be scary. Remember to evaluate your goals, your needs, and your budget before you make your final decision.
