Do you know what you want from a Medicare Plan?
Unless you are on 100% share of cost Medicaid (Medi-Cal in CA), I don’t recommend that you have Original Medicare alone. You can watch this 15 minute Medicare video to understand the differences between plan types.
Because of the potential for unlimited costs, you’ll want to cover yourself with either Medicare Advantage or a Medicare Supplement Insurance Plan.
Whether original Medicare plus a Medicare Supplement plan or a Medicare Advantage plan is right for you will depend on your unique needs and circumstances. It depends on what is most important to you when you are healthy and when you are sick. Here are some topics to consider:
Does your Medicare Plan allow you to receive care from the doctor and hospital of your choice?
Under original Medicare, you can go to whichever specialists and hospitals you choose. This means you can go whenever you need to, without a referral from another doctor. Medicare private plans (Medicare Advantage) could limit your ability to get care from the doctor or hospital of your choice. Even if you have a PPO, there may be extra charges for out-of-network care. If provider choice is a priority, consider original Medicare with added protection from a Medicare Supplement insurance policy. This type, sometimes known as Medigap, isn’t a true “Medicare Plan” but is a supplemental policy. Normally, people who want more choice in a Medicare plan will choose a Medigap policy.
Does your Medicare Plan fit your monthly budget?
If you are on a tight budget and are willing to limit your choice of doctors and hospitals, you may be able to reduce your health care expenses and get coverage of additional benefits through a Medicare plan called Part C or Medicare Advantage. Be sure to review the scope and limits of additional benefits when choosing among available plans. It is also important to look at how much your out-of-pocket costs will be if you get sick. For example, some Medicare private plans charge a copay for each day of an inpatient hospital stay, while original Medicare charges only a deductible but no daily copays for the first 60 days of a hospital stay. This type of Medicare plan can be affordable on a monthly basis, but be sure to check out what your true costs will be.
Does your Medicare Plan give you coverage anywhere in the US?
Under original Medicare, you will be covered for care anywhere in the United States. While private plans must cover emergency care for members outside the plan area, most Medicare Advantage plans do not cover other health care services while away from home. For example, Medicare Advantage HMOs has more restrictive networks of doctors and hospitals that limit coverage away from home.
Do you have benefits from an employer?
If you are considering joining a Medicare private plan (either a Medicare Advantage plan or a stand-alone prescription drug plan), you should talk to your employer or former employer to be sure you won’t lose valuable retiree health benefits if you sign up for a private plan. Many employers offer retiree health coverage as a supplement to traditional Medicare; Some also offer coverage through Medicare HMOs and other private plan options.
Coordinating with Medicaid benefits
If your income and assets are quite modest, you may qualify for Medicaid benefits or other special programs that will help pay some of your health care costs. For those who qualify, Medicaid (Medi-Cal in CA) often pays for valuable benefits, such as nursing home care, and also pays Medicare premiums. If you are already covered by Medicare and Medicaid, you should find out what you must pay to join a Medicare private plan and whether Medicaid will cover the plan’s copayments.
If you’d like to watch a 15-minute video that explains how Original Medicare works, and the differences between Medicare Advantage and Medicare Supplement Insurance (Medigap), go to MedicareQuick.com/Course