Healthcare is an important part of your life, but it’s especially important to understand health insurance, including what is and isn’t covered. Knowing the differences between Medicare, Medigap, and Medicare Advantage will also help you save money and stress in the long run when it’s time to sign up. Here’s a basic guide to what you need to know.
How to Sign Up
When it comes time to sign up for Medicare, visit the website ssa.gov. If you’re not comfortable with the internet, search “how to sign up for Medicare” and look at a few links that can help walk you through the process. There are some great online resources that can make signing up a lot easier and help you understand the coverage you need.
What Medicare Covers
This covers hospital visits and home healthcare. It also has limited coverage for assisted living and nursing home care. For people who worked and paid taxes for at least 10 years, Medicare Part A won’t cost them anything in monthly premiums. However, deductibles still exist.
Parts A and B are considered part of “Original Medicare.” Part B offers outpatient coverage, including doctor visits, lab work, and preventive care such as flu shots and mammograms. It also covers ambulance services, expensive hospital care, and chiropractic services.
This part is also known as Medicare Advantage. According to CNN, Medicare Advantage has been expanded in recent years to sometimes cover things like home accessibility modifications, transportation to medical appointments, and even home-delivered meals. However, these benefits won’t be universally available, so it’s vital that you check first.
This part is pharmaceutical coverage. Recent policy changes have incentivized plans to reduce the cost of pharmaceuticals and reinsurance costs. This can help if you have certain prescriptions, many of which cost hundreds of dollars and are difficult to afford.
What Medicare Doesn’t Cover
Things like long-term care aren’t covered by Medicare. Original Medicare (not Medicare Advantage) also doesn’t cover dental, hearing, or vision care — except for glaucoma and cataracts. Medicare Advantage is likelier to cover any dental, vision, or hearing needs. Remember to ask your doctor why certain prescriptions or services are needed. Then, ask if Medicare covers them. You can avoid high bills this way.
Coverage from Medicare Advantage
Medicare Advantage can help you with preventive care, but there are also other benefits. For example, it can help cover home health-related modifications, as well as a home aide who can assist you with your basic needs. With Medicare Advantage, you can enroll through a private insurance company like Humana. However, it comes with its own trade-offs. The premiums vary widely according to who you enroll with. In addition, copays, deductibles, and drug formularies add up to a much more expensive bill.
Medigap can be a supplement to Medicare. It goes through private insurance providers to cover things like doctor’s visit copays and hospital out-of-pocket costs that aren’t covered with just Medicare. It also broadens your network of providers, which is very handy if you have a special medical condition. You can’t use Medigap with Medicare Advantage, however.
Research has shown major regional variation in what Medicare pays for the same services. It’s worth considering the pros and cons for all of the plans and options you get with Medicare. Weigh them carefully and do research according to where you live. Consider your present and future needs, which will help you make a decision