Welcome to Medicare - EZ Guide

Approximately 10,000 people a day in the United States, that’s how many people since 2011 that age into Medicare everyday.  These numbers will continue until around 2030 as the last of the Baby Boomers age in.  That’s a lot of people being introduced to a healthcare system and benefit structure that is likely unlike anything they have ever had before. Because of this we decided to put together a short guide to Medicare benefits and a basic overview of the structure of Medicare plans. 

Medicare is often described as complicated because of the different programs and plan types offered by organizations. The available plans include offers by private firms in line with established guidelines and programs and Medicare plans called Part C plans.  I’m going to just give you the basics here.  If you want more detailed information you can checkout my other Medicare-focused articles or if you live in Central and Southern Indiana, we can meet up or talk on the phone.

Breaking it Down

You basically have 3 options when it comes to Medicare:

Option 1 – Original Medicare services

It consists of parts A, B & D.  Part A of Medicare is part of original Medicare which comes at no cost for persons that paid for it during their working years or the working years of their spouse.  It covers hospital stays and other inpatient services and has a deductible of around $1,400 a year.  Once the deductible is met in some cases you’ll pay a 20% co-insurance, in other cases you won’t.  Part B is the part of Medicare that covers outpatient services.  If you or a spouse had income under $174,000 in 2018, you’ll pay $144.60 a month for your Part B coverage.  It has a deductible of almost $200 a year and then co-insurance of 20%.  Part D is the Medicare drug plan.  There is no one Medicare drug plan, only standards that Medicare sets.  The idea is to find the plan that has the lowest overall cost when you factor in drug cost and monthly plan premium cost.  I or another reputable Medicare agent can help you determine the best overall Part D plan for your needs.

Option 2 – Original Medicare with a supplement, is keeping your original Part A and B Medicare coverage in place.  However, you pick a Medicare supplement (aka Medigap) plan to help pay the out of pocket cost.  There are several different Medgap plan letters, Plan N, Plan F, Plan G, etc.  The idea is that by having a uniform system of Medigap plans consumers can shop around easier.  Once you know the plan type you want, you just need to find a reputable carrier that is offering that plan type in your area at a good price.  Because a Plan G is a Plan G is a Plan G.  It doesn’t matter who you get that Plan G from, it covers the same medical benefits.

Option 3 – Part C (aka Advantage) is kind of like saying thanks but no thanks Medicare, I choose Aetna, or United, or whoever, to administer my Medicare coverage.  Now you play by that carrier’s rules.  At a minimum, they have to cover what Original Medicare covers, but many have different ways of doing this.  Many plans do not have deductibles, but instead of copays.  Copays are set dollar amounts for various services. So for instance, a primary doctor’s visit might be $5, a lab might be $10, an outpatient surgery could be $200, and so on.  Often part D drug coverage is included in these plans, so you won’t have separate drug coverage.  Depending on the competition in the area, oftentimes these plans will add on extras like dental, vision, credits for OTC items, and gym membership.  In many cases, these plans will not cost you any additional money beyond your Part B premium as well.

That’s the basics of your Medicare options. The whole process of choosing the right Medicare option as you turn 65 could be especially frustrating without the help of an expert Medicare agent. An expert that is versed in Medicare plans can help you find plans that are most suitable to your needs. The importance of understanding the terms and conditions that apply to every insurance policy cannot be overemphasized either. A good health insurance professional will provide guidance based on expert knowledge of the industry.