Understanding Your Medicare Choices

Parts A, B, C and D

When it comes to choosing Medicare a policy that is best for you, it is so important to research your options. There are a lot of choices available – use this guide to help you.

(Click on any section title or arrow below to reveal Understanding Medicare Choices in detail – click on the arrow to close)

(1) Important Questions About You
  • Are you healthy or do you have chronic conditions?
  • How much do you spend on your prescription drugs and how often do you take them?
  • Who are your doctors? How do you feel about seeing new doctors?
  • Besides Medicare, are you eligible for any other health care coverage? If yes, will you keep that coverage when you retire?
  • How does health care impact your budget?
    • Will you need financial help to pay for your Medicare premiums?
    • How much did your health care cost in the last year?
    • Do you expect similar costs this yer?
  • Do you like to travel – how often and where?

(Tip : it is a good idea to write these points down – they will help with understanding Medicare choices and serve to formulate the best plan for you)

(2) Find A Plan That Is Right For You

You have choices that work best for you –

  • Do you only want Original Medicare (Parts A and B)? – with a Part D stand-alone prescription drug plan?
  • Would you rather have a Medicare Advantage plan (Part C) – like an HMO or PPO?
  • If you prefer the Medicare Advantage plan, should it include prescription drug coverage?

Remember : It is in your best interest to consider enrolling as soon as you become eligible – this could save you higher monthly premium costs.

If you have a lower income and are eligible, there is financial help to pay for your Medicare.

(3) Eight Things You Should Know...
  1. There are two ways to get Medicare;
    • Original Medicare (Parts A and B) provided by the government.
    • Medicare Advantage plans (Part C) offered by private insurance companies.
  2. Original Medicare does not pay for everything
    • Even though you have contributed to the costs of your Medicare by paying taxes, you will still have to pay a share of monthly premium costs and copays.
  3. Medicare Supplement Insurance can help you cover out-of-pocket expenses.
    • This will will help you cover costs like deductibles and copays that are not covered by Part A and Part B.
  4. As a Medicare member, you are entitled to get optional prescription drug coverage (Part D).
    • You can enroll in a stand alone Part D plan with your Original Medicare.
    • Or, you can enroll in a Medicare Advantage plan that includes prescription drug coverage.
  5. The state you reside in may offer different choices.
    • Parts A and B (Original Medicare) is the same across the United States.
    • Medicare Advantage (Part C) and prescription drugs (Part D) may be available only in certain counties, states or regions as they are offered by private insurance companies.
    • Medicare supplement policies are available by state and offer nationwide coverage.
  6. Be sure to enroll at the right time.
    • The Initial Enrollment Period (IEP) is your first chance to enroll in Medicare – this is three months before your 65th birthday month, the month of your birthday, and the three months after your birthday month.
    • Coverage starts on the first day of your birthday month if you enroll before the month you turn 65,
    • If you enroll during your birthday month or later, coverage starts on the first day of the following month.
  7. Review your plan once a year.
    • You can change your plan each year during the Medicare Open Enrollment Period (OEP).
    • OEP runs from October 15 to December 7.
  8. Special Election Period.
    • In certain cases you may be able to enroll or switch plans outside the IEP and OEP, for example, you retire and leave an employer or union health care plan; you move out of the service area of your current plan.

Understanding Medicare Choices at a glance

understanding medicare choices

Step 1

 When eligible, enroll in Original Medicare.

Part A – Covers hospital stays

Part B – Covers doctor and outpatient visits

(If you need more coverage, you can choose Step 2 option 1 OR option 2)

understanding medicare choices

Step 2 (Option 1)

Keep Original Medicare (Step 1) and add:

Medicare Supplement Insurance (covers all or some costs not covered by Original Medicare)

and/or

Part D – covers prescription drugs (offered by private companies)

understanding medicare choices

Step 2 (Option 2)

Enroll in Medicare Advantage (Part C)

Combines Parts A and B

Most plans cover prescription drugs

Additional benefits (usually at extra cost)

 

Understanding Part A - Hospital coverage

Part A covers hospital stays and skilled nursing after a hospital stay. It also assists with some home-bound skilled care and hospice care.

  • You can choose any qualified provider in the USA who accepts new Medicare patients.
  • Some coverage limits apply – if you are hospitalized or are in a skilled nursing facility for more than 90 days, you may have to pay for part of the costs.
  • Doctor services in the hospital are not covered under Part A.
  • You will not pay a premium for Part A if you or your spouse have contributed to Social Security for at least 10 years.
  • Your share of the costs will include:
    • deductible – that is determined each year, for example, in 2015 the deductible was $1,260 for each hospital stay.
    • copay – after staying a certain number of days you are liable for copays. These increase for extended stays.
    • coinsurance – applies to inpatient respite care for hospice patients.

Consider adding Medicare Supplement Insurance to cover Part A and B out-of-pocket expenses – see Medigap.

Understanding medicare choices will be much easier with a LifeSmart expert to assist you.

Understanding Part C - Medicare Advantage

Medicare Advantage plans (Part C) are run by private insurance companies. These plans combine coverage for certain hospital costs, doctors visits and other medical services – they may also include prescription drug coverage.

  • All covered under one plan.
  • Dependent on the plan, you can choose a primary care doctor or you can visit a provider who accepts the plan’s terms, conditions and rates.
  • Part C plans have appointed service areas and nationwide emergency coverage.
  • Coverage limits vary according to different plans.
  • Part C plans cover the same services as Part A and B except for hospice care under Part A.
  • Your share of the costs:
    • Plan premiums vary widely.
    • Plan details will tell you if they have deductibles or not. Many do charge copays or coinsurance.
    • For prescription drugs, you may be subject to a coverage gap.

Understanding Medicare Choices – by LifeSmart

Understanding Part B - Doctor visits

Part B covers the costs of medically necessary doctor visits and medical services such as outpatient care at hospitals and clinics, laboratory tests, certain diagnostic screenings, and some skilled nursing care

  • You can choose any qualified provider in the USA who accepts new Medicare patients.
  • Some coverage limits apply – limits on occupational therapy, and limits on screenings are covered only for specific times.
  • Vision, dental and hearing is only covered under certain situations under Part B.
  • Part B does not cover care outside the USA.
  • Your Part B premium is dependent on your yearly income. Most people pay a monthly premium.
  • If you receive Social Security, premiums will be automatically deducted from your benefits.
  • Your share of costs will include:
    • deductible – in 2016, you have to pay a $166 annual deductible before Part B starts paying costs.
    • copay – outbound hospital service copays range. For example, in 2015 this was from a few dollars up to $1,260.
    • coinsurance – after you have met your deductible, Part B generally covers 80% and you have to pay the remaining 20% coinsurance.

Consider adding Medicare Supplement Insurance to cover Part A and B out-of-pocket expenses – see Medigap.

Understanding medicare choices will be much easier with a LifeSmart expert to assist you.

Understanding Part D - Prescription drugs

Medicare Part D plans help you pay for prescription drugs – these plans are optional. If you don’t sign up when you become eligible, you may be subject to a higher premium later when you do enroll.

  • These plans are sold by private companies.
  • The government set the guidelines and the plans offer different drug lists and costs.
  • The Part D plan details will inform you what pharmacies you can use and limitations which may apply. Check to see if your plan offers a mail order service?
  • Coverage limits in terms of cost and drugs offered vary widely dependent on the plan.
  • Most plans have a coverage gap (donut hole) where you will have to pay some of the costs.
  • Premiums for the following year are announced in October. Premiums may vary even though plans offer the same drug coverage – do get an annual free plan checkup from LifeSmart!

Understanding Medicare Choices – by LifeSmart