How to Make Sense of Medicare and Make the Right Choices for Your Healthcare

February 18, 2019

Trying to navigate the waters of Medicare, Medigap, and Medicare Advantage can be as clear as mud — but all hope is not lost. Anyone who is 65 years or older or those who have qualified for Social Security disability for 24 months become eligible to enroll in Medicare. If you fit into either of those categories, it’s time to begin understanding the basics. Look no further than right here for a brief overview of what you are looking at and a discussion of what you need to consider.

The Starting Line

Medicare has 4 parts(not plans) known as A, B, C, and D. On the first day of the month you turn 65, you are eligible for Parts A, B, and C. Part A is your hospital care, which covers things like room and food in the hospital or skilled nursing facility. Part B is your outpatient care that covers things like doctor visits, medical equipment, labs, surgeries, testing, and all other things not covered in Part A. Part C is also called Medicare Advantage, and that’s all you need to know for now. Part D is your prescription drug coverage, which helps you purchase medications at a reduced rate.

Can’t Forget About the Price Tag

Like most things in the world, everything has a price. Generally speaking, Part A is free for you if you or your spouse has worked in the US for 10 years. The cost of Part B depends on your income, based upon the past two years of your tax returns. Part B has a base rate that most people pay, which is then modified if you’re in a higher tax bracket. About now is when things get tricky.Part Dhas a variety of premiums, with typically 20 plus options; like Part B, the higher income earners have increased rates. Part D will require you to do someresearchon the Medicare website to determine which category of coverage you need.

If all of this sounds too good to be true, that’s because it is. Medicare covers most healthcare costs, but in addition to the premiums, you are responsible fordeductibles, copays, and coinsurance. Additionally, there’s a time limit on certain benefits. If you’re hospitalized for 60 days, you will be required to pay a deductible (right now it’s under $1,500). After 60 consecutive days, Medicare will pay a reduced rate. Then you’ll begin owing more due to paying part of the actual hospital bill, which is where supplemental insurance comes into play. Part B requires you to pay a small yearly deductible and then 20 percent of all outpatient services, again requiring supplemental insurance.

Supplemental Insurance or Plan C

We know that Parts A and B require you to havesupplemental insurance, so if you choose to go with Part A and B, it’s time to determine what kind of supplemental insurance is best for your health and budget. Medigap plans come into play once Medicare Parts A and B have paid their share, and then they will cover your percentage and sometimes your deductible. The10 Medigap plansare pricey, but they provide you with more security and freedom in choosing providers that participate in Medicare.

Medicare Advantage (Part C) allows you to see a limited amount of providers that participate in the network and pay a copay, and it sometimes covers prescriptions. But it may not cover the prescription you need. If you intend to stay local, and you don’t need your choice of specialists or uncovered medications, this may be just the choice for you. Check out plansby state to find the right fit for you.

As confusing as Medicare, Medigap, and Medicare Advantage are, you can learn to navigate the waters and make the right healthcare decisions for you. In some cases, you may need to turn to an actual Medicare adviser. Regardless of whether you seek help, it’s critical to do detailed research on all four parts and what they can offer you. Take a look at your budget and consider the costs and advantages of supplemental plans. Most importantly, don’t wait to get started. The best time to plan for the future is now.

Guest Blog by Sharon Wagner

Sharon created SeniorFriendly to provide helpful tips and advice to seniors on staying healthy and making the most out of life. She is the author of the upcoming books, The Ultimate Guide to Senior-Friendly Workouts, Fitness Gear, Healthy Recipes, and More.


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One thought on “How to Make Sense of Medicare and Make the Right Choices for Your Healthcare

  1. EasyFit

    Very nicely described in parts A, B, C, & D. Your blog is really good and I enjoy a lot while reading your blog articles. Thanks for sharing!

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