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How to Choose the Right Medicare Plan for Your Needs

August 3, 2020 By Matt Wolleat Comments are Off

Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD). When you first enroll in Medicare – and during certain times of the year – you have access to several coverage options that are designed to supplement Original Medicare.

At Minnesota Benefit Association, our mission is to help you understand various types of insurance benefits and determine which coverage best meets your needs. We understand every Medicare decision is personal, and we’re here to help! Let’s take a look at the basics of Medicare and how to choose the right plan for your lifestyle.

What Is Original Medicare?

The two main ways to get Medicare coverage are through Original Medicare or a Medicare Advantage Plan. First, let’s talk about Original Medicare.

In 1965, President Lyndon B. Johnson signed Medicare into law. It had two complementary parts, A and B, which are now known as Original Medicare:

  • Medicare Part A (Hospital Insurance): Part A covers hospital stays, care in a skilled nursing facility, hospice care, and some home healthcare.
  • Medicare Part B (Medical Insurance): Part B covers certain doctors’ services, outpatient care, medical supplies, and preventative services.

 

While Parts A and B provide widely accepted coverage for inpatient and outpatient services (you can use any doctor or hospital that takes Medicare, anywhere in the U.S.), there are additional costs associated with the care that Original Medicare doesn’t cover.

For example, with Part A, you’d have to pay a deductible before your benefits kicks in to cover your hospital stay, and with Part B, you might pay coinsurance at your appointment, and your doctor may prescribe drugs after your visit. These costs can add up.

To help people with the out-of-pocket expenses associated with Original Medicare, the government partnered with private insurers to create supplemental coverage plans. This includes prescription drug coverage (Medicare Part D), Medicare Advantage plans (Medicare Part C), and Medicare Supplement Insurance (Medigap).

What Is Medicare Part D?

Anyone who has Medicare can access drug coverage. It’s an optional benefit that can be obtained by either adding a Part D plan to Original Medicare (which would be a separate policy with a separate monthly premium), or purchasing a Medicare Advantage plan that includes prescription drug coverage.

A couple things to know about drug coverage plans:

  • Each plan that offers prescription drug coverage through Medicare Part D must give at least a standard level of coverage set by Medicare.
  • Plans can vary the list of prescription drugs they cover (called a formulary), as well as how they place drugs into different tiers on their formularies.

If you’re looking for coverage that goes beyond Original Medicare, adding drug coverage can help ensure you’re able to afford your prescriptions. But if you want even more benefits that Medicare Part A, B, and D don’t cover, you may be interested in a Medicare Advantage plan.

What Are Medicare Advantage Plans?

Now that we’ve gone through Medicare A, B, and D, you might be wondering what happened to C! Sometimes called Part C or MA Plans, Medicare Advantage plans are designed to provide an all-in-one alternative to Original Medicare. Like other types of supplemental coverage plans, they are purchased through private companies approved by Medicare.

Though not all Medicare Advantage plans work the same way, these bundled plans typically include coverage for Medicare Part A, Part B, and Part D, plus extra benefits like vision, hearing, dental, and long-term care. Some MA plans even cover wellness costs for things like gym memberships.

The most common types of Medicare Advantage plans are:

Important things to know about Medicare Advantage plans:

  • If you join a Medicare Advantage plan, you still have Original Medicare. Medicare pays a fixed amount for your care each month to the provider of your Medicare Advantage plan.
  • With Original Medicare, you can go to any doctor that accepts Medicare. But with a Medicare Advantage plan, you may need to use health care providers who participate in the plan’s network. If so, you’ll want to find out how close the network’s doctors and pharmacies are to your home. Some plans offer out-of-network coverage.
  • With Original Medicare, there’s no limit on how much you pay out-of-pocket per year, unless you have supplemental coverage. With a Medicare Advantage plan, you have a yearly limit on your out-of-pocket costs. Once you reach the limit, you pay nothing for covered services for the rest of the year.
  • Once you’re on a Medicare Advantage plan, you cannot access Medigap, which we’ll discuss next.

What Is Medicare Supplement Insurance (Medigap)?

Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare coverage – things Part A and B don’t cover, such as copayments and coinsurance. You must have Original Medicare to purchase a Medigap policy.

If you have Original Medicare and you buy a Medigap policy, Medicare first pays its share of the Medicare-approved amount for covered health care costs. Then, your Medigap policy pays its share.

Other important things to know about Medigap policies:

  • Medigap is insurance coverage sold by private companies that agree to abide by federal Medicare guidelines. You can buy a policy from any insurance company in your state that’s licensed to sell one.
  • Some Medigap policies cover medical care when you travel outside the U.S.
  • Medigap policies only cover one person. This means a married couple needs two policies, one for each spouse.
  • A Medigap plan cannot be used in conjunction with a Medicare Advantage plan. However, if you join a Medicare Advantage plan for the first time and aren’t happy with the plan, you have special rights under federal law to switch to Original Medicare and buy a Medigap policy.

Medicare Advantage vs. Medigap

If you want coverage beyond Original Medicare, it can be tricky to decide your best course of action. You can either enroll in a Medicare Advantage plan that satisfies all your wants and needs, or stick with Original Medicare and purchase supplemental coverage plans, like Part D and Medigap.

Here are a few takeaways about Medicare Advantage plans and Medigap:

  • A Medigap policy is different from a Medicare Advantage plan, because it only supplements your Original Medicare benefits. (Doesn’t cover things like long-term care, vision, or dental that are included in some MA plans.)
  • It may be more cost effective to join a Medicare Advantage plan because your cost sharing is lower (or included).
  • You can’t use (and can’t be sold) a Medigap policy if you’re in a Medicare Advantage plan.

We’ll Help You Choose a Medicare Plan Based on Your Health, Budget & Lifestyle

At MBA, we understand that choosing the best Medicare plan can be a daunting task. There are many factors to consider, but the main things to assess are your lifestyle preferences, medical needs, and budget.

When you contact us, we’ll work as your Medicare advocate, offering free advice to ensure that you understand all of your options and feel confident about selecting a plan. When you have questions, our licensed advisors have answers, so give us a call at 651.358.2990