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How to Pick the Right Medicare Plans for You
By Crystal Manning

Deciding whether to enroll in Medicare is an important decision, so you will want to make sure you are as knowledgeable about this health coverage program before you make it. You also need to be aware of enrollment requirements and timeframes. If you miss your initial enrollment period, which begins three months before you turn 65 and runs until three months after, then you will need to wait until a general enrollment period opens, unless you qualify for special enrollment. Also, keep in mind that if you fail to sign up for Part B or prescription drug plan (part D) when you first become eligible and do not have an approved exception, you face penalty premiums for each year you do not register.

What is Medicare?
Medicare is a federal health insurance program, primarily for people who are 65 years and older. It has four parts, each of which has a distinct intent:

  • Medicare Part A: Covers hospital stays, care in a skilled nursing facility, hospice care and some home health. Deductibles & copays are the patient responsibility.
  • Medicare Part B: Covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Medicare pays 20% of all covered expenses – except for the annual deductible ($203 in 2021).
  • Medigap: Supplemental coverage for Parts A and B provided by private insurers that in most cases eliminates all copayments, coinsurance, and deductibles.
  • Medicare Part C (also known as Medicare Advantage): Supplemental coverage provided by private insurers that often reduces copayments and coinsurance and may include dental, vision and prescription coverage.
  • Medicare Part D: Supplemental plans that cover prescription drugs costs for Parts A and B supplemental plans. Prescription coverage is mandated by Medicare. You will incur a penalty if you do not have creditable prescription coverage which remains in effect for as long as you have coverage.

Medicare C or Medigap: What are the differences?
Now you have Medicare A & B how can you avoid the high copays & deductibles from Medicare? You cannot purchase both Medicare Part C and Medigap. You will need to choose the option that best fits your needs. Here is how they compare:

Medicare C (Medicare Advantage) - (Follow Rules)

  • Lower premiums
  • Higher out-of-pocket costs that vary by plan; each plan has an out-of-pocket maximum.
  • HMO or PPO option: possible limited in-network doctor selection or out-of-network rules.
  • Referral to see specialist often required.
  • Usually only local or regional coverage.
  • Usually includes Medicare Part D as part of the premium.
  • Some include extra coverage for vision, dental and hearing aids and exercise programs.

Many Medicare Advantage plans offer zero to various premiums. With more Medicare Advantage plan options being sold by more providers, the increased competition between insurance companies helps keep costs low for consumers. And with more benefits being approved for use, plan providers may gain even greater flexibility with their pricing and coverage offerings.

If you sign up for Medicare Advantage, review your coverage annually. Coverage, benefits, and costs of Medicare Advantage plans change each year. Reviewing your plan could save you money, help you find a better coverage fit — or both.

Medigap (Medicare Supplement Insurance) - (Peace of Mind)

  • Higher premiums – little out of pocket.
  • Usually, Medicare annual deductible, which is $203 in 2021, depending on the plan you choose.
  • Accepted everywhere that Medicare is accepted.
  • Usually, referrals are not required to see a specialist.
  • Generally accepted in every state or U.S. territory and some plans may be accepted internationally when traveling.
  • Medicare Part D must be purchased separately.
  • Coverage for extras must be added through additional plans.
  • Note -- Those who need frequent medical care, or like to budget with fixed costs, often choose Medigap to keep their total medical costs flat.

Choosing the right insurance plan is the most important decision you will make for your future health. You need to make some of the most consequential decisions about Medicare at a time when you know the least about Medicare. As a licensed Medicare Advisor, Crystal Manning can assist with many options that are best for you. Contact her at (412) 716-4942 or crystalmanning33@gmail.com.



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