How To Pick A Plan That Works Best For You?

Medicare is a comprehensive health insurance program offered by the federal government. It is divided into four parts, and each has its own specific coverage for the cost of hospitalization, medical, and additional services. Medicare also offers approved private insurance coverage for costs that don’t come under original Medicare.

Medicare comprises the following options.

Part A – Hospital expenses including hospital care, skilled nursing facility care, certain home health services, and hospice care (including home and inpatient specific care) are covered under this part.

Part B – Medical expenses for necessary services and preventive services. Clinical research, ambulance services, durable medical equipment, and mental health care costs (inpatient, outpatient, and partial hospitalization) are among other costs that are covered by this plan.

Part C – Medicare Advantage Plans cover those specific costs which don’t form part of original Medicare. These are the plans which have been approved by Medicare offered by private insurance companies.

Part D – Includes prescription medications with a list of pre-approved medications for the coverage.

Understanding Medicare
Medicare provides comprehensive health insurance coverage, which is why a number of factors have to be taken into account while choosing Medicare plans.

  • Educate yourself thoroughly to understand the different parts of Medicare since each part is designed to cover and include specific services and expenses.
  • It is to be noted that original Medicare includes Part A and B primarily. Part C and D are additional plans and services offered by private companies.
  • There is an open enrollment period for Medicare, which allows you to opt for plans in the 7-month initial period which starts three months before you turn 65 and ends three months after you turn 65. This also includes the month you turn 65.
  • Under original Medicare, it is advisable to opt for Part A coverage once you turn 65. A few people opt for Part B since a monthly premium is applicable in case Medicare taxes are not paid. For Part A, the monthly premium is not needed since Medicare taxes have been paid during employment.
  • Coverage option for parts A and B will be different from the plans available for Medicare Prescription Drug Coverage or Medicare supplement insurance.
  • In some cases, you are automatically enrolled for Medicare at the age of 65.

Tips to pick a Medicare plan that works best for you

  • Find out if your primary health care providers like doctors and practicing professionals are covered under the network approved by Medicare. Choose Medicare plans that cover your primary care providers within the approved network to avail reimbursements later from your insurance provider.
  • Original Medicare and Medicare Advantage plans are two different insurance options. For serious medical conditions, it is advisable to opt for original Medicare over the Advantage Plans. Original Medicare will cover the cost of hospitalization and medical expenses incurred during the course of your treatment from your primary care provider or specialist. Even if you have opted for Medicare Advantage, it is in your best interest to switch to original Medicare during this period.
  • Health and medication plans offered under Part D will have a list of prescription medications that are approved by Medicare. This should be verified as the list is updated depending on the plan you choose. Ensure that you don’t incur any additional costs for medications after paying for Part D plans by checking the updated list.
  • Plans under Medicare include a list of preferred pharmacies as well. This will affect the price of medications that have been pre-approved under Medicare
  • For frequent travelers and people who spend their winters in Florida, snowbird coverage plan is available, especially designed for this purpose. This plan will ensure you don’t end up paying out-of-pocket medical expenses while being out of Medicare network coverage
  • The official website of Medicare offers a useful plan finder tool. This online resource can be used to estimate the premium as well as the total plan cost. The estimated annual health and medication costs along with out-of-pocket expense limits should be taken into account while choosing plans. This is applicable for expenses within your Medicare-approved network and outside the network.
  • The federal government also provides ratings for different types of Medicare plans available. Choose from plans which have a 5-star excellent rating or at least a 4 to 4.5-star rating to make the most of Medicare and Medicare Advantage plans.
  • In comparison, premiums paid for Medicare Advantage plans will be lower than original Medicare and supplemental insurance. Deductibles should also be taken into account since these are the amounts that you will pay for the treatment and medical services out of your pocket before the primary insurance provider takes care of the expenses.