Which Medicare Plan Is Best for You? – Orange County Registry

By Jose Juarez

Contributing Author

Medicare is a federal health insurance program available to US citizens or permanent residents, primarily those who are at least 65 years of age. Other Medicare beneficiaries are those with certain disabilities or conditions.

However, Medicare coverage can be complex, and it’s not always clear which plan is best for which person. With the annual election period scheduled to begin later this month, here is an introductory guide to help you.

What is Medicare?

Medicare consists of four parts:

• Part A: Hospital insurance, which helps cover inpatient care in hospitals, nursing homes, hospices, and home care.
• Part B: Health insurance that covers medical, ambulance, laboratory testing, medical equipment, and health screening services.
• Part C: Medicare Advantage, which is offered by private insurance companies and provides the benefits of Parts A and B, often including Part D.
• Part D: Help with prescription drug costs not covered by Original Medicare.

Original Medicare or Part A and B

Part A and B of Medicare make up what is known as “Original Medicare,” which covers medical services and supplies in a hospital, clinic, or other healthcare facility. Part A covers hospital insurance and Part B covers health insurance, and both are administered by the federal government through Original Medicare.

With Original Medicare, you can generally see a general practitioner, specialist, or hospital that accepts Medicare in the United States

With Original Medicare, you first pay a deductible, a set amount for your health care. Then Medicare pays its share while you pay the co-payment for covered services and supplies. Since Part B covers more routine services and consumables, you typically have to pay a monthly premium of about $170.10 for 2022 ($164.90 in 2023). The amount can change every year and can be higher depending on your income.

medigap

Medigap is a supplemental plan that helps fill “gaps” in Original Medicare.

Original Medicare pays for most, but not all, of your healthcare services and supplies. A Medicare Supplement Plan (Medigap) policy can help you pay for remaining healthcare costs such as co-payments, coinsurance, and deductibles.

Medigap policies do not cover the following services: long term care, vision, dental or hearing aids.

Medicare Advantage or Part C

Part C, or “Medicare Advantage,” addresses Medicare-approved private insurance plans that provide beneficiaries with Part A, Part B, and Part D coverage.

Not all Medicare Advantage plans work the same way, however. So make sure you find and compare the different plans available before you join.

In most cases, you’ll need to use doctors who are part of the plan’s network, but the plans may have lower upfront costs as a result. Medicare Advantage plans can also provide a variety of helpful benefits.

All of the plans offered cover the same services and supplies that Original Medicare offers. This gives you access to hospital services, skilled nursing facility care, hospice care, and medical services that may be medically necessary or preventative.

However, in addition to your basic coverage, Medicare Advantage plans can provide additional benefits. These benefits vary, so look at each plan to see which benefits best suit your medical needs. Additional benefits you may find in a Medicare Advantage plan include:

• dental care.
• Ear protection.
• vision cover.
• Over-the-Counter Benefits.
• Day care for adults.
• transportation to health services.
• security devices for domestic use.
• Delivery of meals.

With Medicare Advantage, you have access to these benefits under a single plan. This access to additional benefits also draws people to choose a Medicare Advantage plan over Original Medicare.

Medicare Drug Plan or Part D

It is very important to understand how your prescription medications are covered as well.

Part D, or Medicare Drug Plan, helps with prescription drug costs.

Many Medicare Advantage plans include Part D at no additional cost. It may be more cost-effective for you to find a Medicare Advantage plan that covers your prescriptions in addition to any additional benefits that the plan may include.

However, if you find that Original Medicare or a Medicare supplement plan better suits your needs, you can add a standalone Medicare drug plan to Original Medicare as well.

It is generally recommended that you still enroll in Part D once you are eligible so that you are covered if you need prescription drugs. If you delay enrollment in a Medicare drug plan, you will most likely have to pay a late enrollment penalty, which becomes a permanent expense that is added to your Medicare Part D premium for as long as you use Medicare. Medicare Part D premiums vary based on application status and annual income.

Annual election period

The annual election period is important.

During this time of year, from October 15th to December 7th, you can look around and compare your current plan and decide if there’s something better near you.

During this period, you can join or enroll in a Medicare Advantage plan, or switch between Original Medicare with or without a Part D plan and a Medicare Advantage plan.

By reviewing your current Medicare health and drug coverage, you can make changes for the next year based on how satisfied you are with your coverage.

Even if you’re happy with your current Medicare coverage, it’s best to look into other options in your area that better meet your unique needs for the year ahead.

For example, there may be other plans in your area that offer better coverage at a lower price, or another Part D plan that covers prescriptions at potentially lower prices.

Jose Juarez is a Medicare Education Specialist at MemorialCare Medical Group. He has years of experience speaking to seniors and educating them on the basics and intricacies of navigating Medicare, finding the best plan for them, and encouraging them to take advantage of the programs and plans available to them.