Considerations when choosing a Medicare plan

The Medicare options available today can sound like alphabet soup. What’s the difference between Part A and Part B? Do you need Part C? And when does Part D come into play?

While Medicare can seem confusing on the surface, understanding your coverage needs, eligibility, and budget, can help you easily narrow down the options. Here, we break down some of the essential factors you need to know before choosing a Medicare plan.

Different Types of Medicare Coverage

There are four parts to Medicare — A, B, C, D. Let’s outline what each part includes.

Part A and B (Original Medicare)

Original Medicare includes Part A and Medicare Part B. The U.S. Government administers these plans. Medicare Part A and B cover many essential medical services, but not all.

  • Part A, also called hospital insurance, covers hospital inpatient care, home health care, skilled nursing facilities, and some hospice care.
  • Part B, also called medical insurance, covers urgent care, ambulance services, durable medical equipment (DME), and some outpatient prescription drugs.

It’s important to know that Original Medicare doesn’t cover most prescription drugs, dental, hearing, or vision.

Part C (Medicare Advantage)

Medicare Advantage plans are administered by Medicare-approved private insurance companies. They cover everything Original Medicare covers except for hospice care.

In addition to all the services covered in Original Medicare, Medicare Advantage Plans can cover:

  • Dental
  • Gym memberships
  • Hearing tests and hearing aids
  • Prescriptions
  • Vision tests for classes

However, coverage varies across different Medicare Advantage Plans. It’s always a good idea to check with your plan on coverage for a specific treatment or service.

Part D (Prescription Drug Coverage)

Prescription drug plans (PDPs), also called Medicare Part D, are private insurance plans that can cover some of your prescription drugs. You will still have deductibles, premiums, and copays for the drugs, but these will vary depending on the plan.

PDPs plans also have in-network pharmacies where prescription copays can be cheaper.

Medicare Plan Costs

Part A and B (Original Medicare)

You likely won’t have to pay a monthly premium for Medicare Part A hospital insurance. This is because you paid taxes into Medicare services while you were working. If you need to pay a premium, you may pay up to $471 a month in 2021.

Medicare Part B medical insurance does have a premium, though. In 2021, the standard amount is $148.50 a month, but that amount can increase based on your income. The deductible for Part B services is $203 in 2021. Once you reach that, you’ll pay 20% of the Medicare-approved amount for the service or treatment.

If you’re enrolled in Original Medicare, you can also purchase a Medicare Supplement Insurance plan or Medigap plan. While coverage doesn’t vary much across the plans, quality and price do. So, make sure to research any Medigap plan you’re considering.

Part C (Medicare Advantage)

The cost for Medicare Advantage Plans varies by plan. However, many plans offer low monthly premiums or $0 premiums.

It’s important to remember that each Medicare Advantage Plan has a specific network of providers, and you could pay higher out-of-pocket costs if you get care outside of that network.

Part D (Prescription Drug Coverage)

Similar to Medicare Advantage Plans, the cost for PDPs will vary by plan. In some cases, your premiums may be more expensive if you have a higher income.

Star Ratings

All Medicare Advantage Plans are not created equal. If you’re shopping around for a Medicare Advantage Plan, keep an eye out for the star ratings. The Centers for Medicare & Medicaid Services (CMS) assigns these star ratings based on a plan’s performance. CMS gathers the data from member satisfaction surveys, plans, and providers. A 5-star rating is “excellent” and a 1-star rating is “poor.”

The rating system looks at factors including:

  • Access to preventive care that helps members stay healthy
  • Member complaints
  • Customer service
  • Overall member satisfaction
  • Care coordination for chronic conditions

Remember Your Other Coverage

Before choosing a Medicare plan, remember that you may have health coverage through your employer if you are still working. Double-check what your employer’s plan covers and make sure it can work with Medicare.

Don’t Forget to Enroll

By understanding these key factors — coverage, price, and star ratings — you can make a more informed decision about which Medicare plan is right for you. And once you do decide, don’t forget to enroll. You could pay a late enrollment penalty if you miss the deadline.

  • The Initial Medicare Enrollment Period starts three months before turning 65 and ends three months after you turn 65.
  • The General Medicare Enrollment Period (if you miss the Initial Enrollment Period) for Part A and B is January 1-March 31. Coverage starts July 1.
  • You can sign up for a Medicare Advantage Plan or PDP when you first sign up for Medicare. If you miss that chance, the Open Enrollment Period for Medicare Advantage and Prescription Drug Plans is October 15-December 7. You can also drop or change your coverage during this period.
  • You can enroll during a Special Enrollment Period if you meet specific requirements.

Next Steps

If you still have questions about Medicare, we’re ready to help. Please call us at 305.541.5366 to schedule an appointment or learn more about the Medicare plans offered through LEON Health.

Ready to Enroll with LEON Health?

As you prepare for Medicare, you’ll be faced with many important decisions. LEON Health wants to help you select the best options for your needs.

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