Is Medicare Right for You? A Guide for Those Over 65

Before signing up for Medicare, you should understand its ins and outs. Contrary to popular belief, it isn’t free, and making the wrong choice can be very expensive. If you’ve been using Medicare, it’s a good idea to re-evaluate your options each year to determine if you’re on the right plan.

You can switch Medicare plans during the annual enrollment period which runs from Oct. 15 through Dec. 7. If you’re considering Medicare for the first time, you should understand the individual parts that make up Medicare.

Part A

This covers hospice, some home health care, skilled nursing, and hospital care. The premium to be paid is determined by your Social Security work credits. It is free for individuals or couples with at least 10 years of Social Security work history, but if you have no such work history, it could cost up to $413 each month.

Part B

This covers hospitals, outpatient care, preventive care, some home health care, and doctors’ visits. The average cost for individual Medicare beneficiaries with yearly incomes of $85,000 (or $170,000 for couples) is $134 per month. For individual beneficiaries with annual incomes exceeding $214,000 (or $428,000 for couples), it could cost up to $428.

Part C

Also referred to as the Medicare Advantage plan, these plans are offered by private insurers that partner with Medicare in the provision of Part A and B benefits to subscribers. Although the premium for Part C is determined by plan and region, the nationwide average is $30.

Part D

This part offers coverage for prescription drugs.

Choosing Between Traditional Medicare and Medicare Advantage Plans

Before choosing a Medicare plan, you should weigh the benefits of Part C (the Medicare Advantage plan) rather than choosing more traditional Medicare. Most beneficiaries choose Parts A and B together with Part D’s drug coverage.

If you opt for traditional Medicare, it’s a good idea to supplement it with a Medigap plan. These are Medicare supplemental insurance plans that cover additional medical expenses not obtainable under Medicare. They are offered by AARP and private insurers and there are significant variations in their cost.

Although you can make do with Parts A and B, the out-of-pocket costs are usually substantial. This is because there are no maximum out-of-pocket costs for traditional Medicare. Subscribing to a Medigap policy will cover most of these costs.

Medicare Advantage Plans

Medicare Advantage plans typically have zero or low monthly premiums; however, beneficiaries can only receive care through network hospitals and doctors. According to reports from the Centers for Medicare & Medicaid Services, over 20 million Medicare beneficiaries will opt for a Medicare Advantage plan next year.

The maximum out-of-pocket limit for these plans (which are basically a combination of PPOs and HMOs) is $6,700, as opposed to traditional Medicare which has no limit on the amount you may spend annually. However, you will have access to a limited number of hospitals and doctors.

For younger, healthier beneficiaries or those who absolutely can’t afford a Medigap policy, it is usually cheaper to go with Medicare Advantage plans. If you can afford it, you should opt for traditional Medicare with supplemental coverage since this offers greater access to top specialists and you don’t need to get approval from the insurer for specific treatments.

Supplemental Rates

For beneficiaries who start out with traditional Medicare and supplement with Medigap, the supplement rate isn’t based on their health records. However, if they start out with Medicare Advantage plans and later switch to traditional Medicare, the premium for the supplemental coverage will be based on health history, and in some cases, the insurer may deny coverage.

Conclusion

The U.S. health care system is complex, and you should seek professional advice before choosing a plan. Pay attention when signing up for Medicare, or else you may end up with a plan that isn’t ideal for you.

Insurers can continue coverage under a Medicare Advantage plan for existing subscribers unless they expressly indicate that they don’t accept the plan. If you’re considering various Medicare Advantage plans, it’s best to contact each company and verify the amount of coverage you will get.

Editor
Editorial Staffs at Healthtian, A team of Writers.