The annual enrollment period for Medicare starts next month on October, 15th. For those that qualify, it’s time to start preparing and planning to figure out your best coverage.
9Health talked with Dr. Robert Morris, the chief medical officer for Well Advised, to sort through all you need to know about Medicare.
9Health has partnered with Well-Advised, a free, unbiased, online tool to help individuals determine their optimal Medicare plan. Click or tap here to try the tool.
Medicare was created to provide health coverage for Americans age 65 and older. The program was expanded in the early 70s to cover younger Americans with permanent disabilities.
There are several different parts of Medicare. They are explained briefly below but it can all still be pretty confusing.
To help sort through your options and decide on the best plan for you use the free tool from Well Advised. Click or tap here to go to Well Advised’s website and try their free online tool.
Original Medicare (Parts A & B)
Medicare Part A covers hospital costs – inpatient care or skilled nursing facility – but not long-term care. Part A also helps pay for hospice care.
Medicare Part A has a deductible and coinsurance. Patients pay a portion of the bill, 20% and Medicare covers 80% but there is no limit on patient out-of-pocket costs
Part B covers doctor visits and other medically necessary services and supplies. That includes preventive services, ambulance, medical equipment, and a few types of outpatient prescription drugs. Medicare Part B requires a monthly premium.
If you’re over 65 (or turning 65 in the next 3 months) and not already getting benefits from Social Security, you need to sign up to get Medicare Part A and Part B. You won’t get Medicare automatically.
If you already get benefits from Social Security, you’ll get Medicare Part A and Part B automatically when you’re first eligible and don’t need to sign up.
What isn’t covered by Original Medicare?
The biggest potential expense that’s not covered by Original Medicare is long-term care, also known as custodial care.
Other common expenses that Original Medicare doesn’t cover include:
- Hearing aids and exams for fitting them
- Eye exams and eyeglasses
- Most dental care
- Medical care overseas
- Cosmetic surgery
- Massage therapy
Part D Prescription Drug Coverage
Medicare Part D covers prescription drug costs. Plans are offered by private insurers and require a monthly premium
Medicare Advantage (Part C)
Medicare Advantage, also known as Medicare Part C, is a type of health plan offered by private insurance companies that provides the benefits of Parts A and Part B and often Part D (prescription drug coverage) as well.
These bundled plans may have additional coverage, such as vision, hearing and dental care. Unlike Original Medicare, Medicare Advantage plans have an annual limit on out-of-pocket costs.
Medicare Supplement Insurance (Medigap)
A Medicare Supplement Insurance (Medigap) policy helps pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.
Medigap policies are sold by private companies. Some Medigap policies also cover services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. Typically Medigap policies still don’t cover long-term care, vision, dental care, hearing aids, eyeglasses, or private-duty nursing.
If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs, then, your Medigap policy pays its share.
Again, this can all be overwhelming and confusing and that’s where Well Advised can help. The Well Advised tool, available at well-advised.com, is free to use. All user information is private, and the results delivered are optimized and non-biased, directly supporting the individual user’s best interests. Manage your care needs and health spending all in one place.
Still have questions? Click or tap here to view a previous webinar that demonstrates the tool.
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