As you probably already know, Medicare is a health insurance program that offers health coverage to Americans who are aged 65 and above. When you are getting enrolled in a Medicare plan, you have plenty of options to choose from. You can opt for Original Medicare, substitute that with a Medicare Advantage plan, or choose a Medicare Supplement Insurance to plan to counter the out-of-the-pocket expenses associated with Original Medicare. You need to check out all the options available to you and the pros and cons of each Medicare plan. You should have a detailed idea about all these before you pick up an appropriate plan for yourself.
Original Medicare – Pros and Cons
The federal government is known to administer and manage the Original Medicare plan. The plan has two parts – Part A and Part B. Each part covers different services. Medicare Part A, also known as hospital insurance, provides coverage for inpatient care, including the care that you receive in a nursing facility and a hospital. Medicare Part B or medical insurance provides coverage for outpatient services, doctors’ services, preventive care, laboratory tests, as well as medical equipment.
The pros you get in Original Medicare are low monthly premiums and broad acceptance. In the case of Medicare Part A, you don’t need to shell out a premium for Part B, the premium starts at a monthly sum of $148.50 as of 2021. The premium amount can be higher based on one’s income. When you have to choose a healthcare provider for the Medicare Part A plan, you get a lot of flexibility. The good news is that most American hospitals, doctors, and healthcare providers accept Medicare.
The out-of-pocket expenses are a basic disadvantage here. Plus, the Original Medicare plan won’t cover the cost of getting an eye or ear checkup.
Medicare Supplement Insurance
You have to buy the Medicare Supplement Insurance or Medigap plans from private insurance companies. The plans won’t deprive you of the benefits that you receive from Original Medicare. On the contrary, Medigap plans, together with Part A and Part B of Medicare cover your medical expenses more extensively. Coming to the pros and cons of Medigap plans, broad coverage is indeed beneficial.
The plans tend to at least partly cover the initial three pints of blood, hospice care coinsurance or copayment, Part A coinsurance and hospital expenses, and Part B coinsurance or copayment. There are several plans you can choose from. There are basically 10 standard plans and all offer basic benefits.
The downside is that if you have got yourself enrolled for Medicare Part A only, you won’t be able to avail a Medigap plan. You have to enroll for Part B. Aside from that, if you are not 65 yet, then a Medigap policy is not for you. Even if you do avail of the plan, you have to shell out a higher premium.
The federal government provides Part A and Part B of the Original Medicare plan. However, Medicare Advantage Plan, also known as Medicare Part C, can be bought from private insurance companies only. Law states that a Medicare Advantage Plan needs to provide the same benefits that are offered by the Original Medicare plan.
Medicare Part C has its advantages and disadvantages. Though Medicare Part C provides you the exact benefits that you get from Original Medicare, a few offer extra benefits. Vision, dental, as well as prescription drug costs are covered by the plan. Moreover, you will come across various forms of Medicare Part C plan, and that includes PPO or preferred provider organization plan an HMO or health maintenance organization plan.
With that being said, strict rules have to be followed. You can’t go beyond the network of healthcare providers pre-determined by Part C, to seek medical care. You will be allowed to do that only in cases when there is an emergency. There are some Part C plans which do allow you to go outside for a service, but you would need to pay. Additionally, if you shift to a place that doesn’t come under your Part C plan, there is every possibility that you will lose your existing plan. In that case, you need to sign up for a different Medicare Advantage plan or Original Medicare.
If you are having difficulties choosing a Medicare plan that would work best for you, take the help of an expert or you might also contact a licensed agent.