10 Things to Know About Your Medicare Options

Sep 23, 2016

Medicare health insurance is provided by the government to U.S. citizens (65 years+) and certain adults with qualifying health conditions and/or certain permanent disabilities. With several Medicare options to choose from, it can get tricky trying to pick the right healthcare plan. To find the best health coverage plan for you, see our top 10 things you should know about your Medicare options.

Original Medicare vs. Medicare Advantage (MA) Plans

1 – Your First Option: Original Medicare
Original Medicare (or Traditional Medicare) is one option, offering Part A (hospital insurance) and Part B (medical insurance) services.

2 –  The Pros of Original Medicare
Medicare is accepted by most hospitals and doctors in the U.S. (as long as they accept reimbursement for covered services at a Medicare-approved amount). Under Original Medicare, you can select your own doctor from a large network.

3 – Cons of Original Medicare
Original Medicare has deductibles, copays, and coinsurance for medical services with no annual cap on cost to the senior.  Beyond the potential high cost, Original Medicare does not provide prescription drug coverage.

4 – Your Second Option: A Medicare Advantage Plan
You could choose a Medicare Advantage Plan instead of Original Medicare. These plans can vary in their services, and health coverage is provided by a private company approved by Medicare.

5 – Pros of a Medicare Advantage Plan
Medicare Advantage Plans cover all benefits Original Medicare does and may also provide a Prescription Drug plan. Medicare Advantage plans may significantly reduce copays & coinsurance for medical services and have a maximum out-of-pocket (MOOP) on covered expenses beneficiaries can pay in any given year.  Most plans include prescription drug coverage, but some plans may require you purchase this separately as Part D Medicare (see number 7).

6 – Cons of a Medicare Advantage Plan
Medicare Advantage Plans often limit the medical providers you may see for covered services. Location may be a downside as well, since MA plans are usually more available in urban areas.

Supplemental Medicare Coverage

7 – Part D: Prescription Drug Coverage
Part D is Medicare prescription drug coverage and can be purchased separately as a Stand-Alone Prescription Drug Plan or included in a Medicare Advantage Plan.  Similar to Medicare Advantage Plans, Part D is run by private companies approved by Medicare and follow rules set by Medicare.

8 – Medicare Supplement Policies (Medigap Policies)
Medicare Supplement Insurance or Medigap policies are sold by private companies and can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.  Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S.  Medigap policy plans are standardized, but can depend upon where you live.

Expenses Under Medicare

9 – Premiums
There’s a monthly premium for Medicare Part B that is adjusted annually by Medicare and must be paid by all beneficiaries who elect to enroll in either Original Medicare, a Medicare Advantage Plan, or a Medicare Supplement Plan.  All Stand-Alone Prescription Drug Plans and Medicare Supplement Insurance Plans have a monthly premium that varies by plan and location. Medicare Advantage Plans may have an additional a monthly cost, and it will be depending on exact plan and location..

Your Best Medicare Option

10 – How to Choose the Best Medicare Option
The best way to choose the right Medicare plan is to assess your current health and budget, project services you think you’ll need in the future, and decide on a plan that ties everything together with a reasonable price.  It’s important to compare the out-of-pocket costs you’ll incur, including deductible, coinsurance and copayments. Although unattractive at first glance, higher premiums could mean lower out-of-pocket expenses.  Looking for a Medicare option that’s right for you? AGA Medicare Options can show you an array of Medicare plans that can work for your unique situation.

Find a plan that fits your needs and budget


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