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Your Guide to Finding the Right Medicare Coverage for You

Your Guide to Finding the Right Medicare Coverage for You

In most states, there are 100+ different types of Medicare coverage plans available each year. The difference between choosing the right plan for your situation and the wrong one can be thousands of dollars per year. But how can you know which one is right for your situation? 

The more you learn about your options, the higher the chances of finding the right Medicare coverage for you.

What is the Medicare Coverage Eligibility?

Medicare Coverage Eligibility: maintaining optimal health

First, you must understand what Medicare is and whether you qualify for it. Medicare is government health insurance that provides coverage for both inpatient and outpatient procedures. However, not everyone can qualify for Medicare since it has age restrictions. The age of eligibility is for individuals 65 and above. Young people with disabilities and individuals with renal disease are also eligible. 

If you qualify to get Medicare, you can proceed to choose the right plan for you. You should note that Medicare Part A, B, C, and D coverage exists, knowing how they work and what they mean is essential as it will help you choose the right plan.

What are the Different Parts of Medicare that Exist?

Medicare Part A

Medicare Part A: Hospital care

Medicare Part A and B also go by the term Original Medicare. Part A covers In-Patient hospital care, hospice, and rehabilitative care. You can get rehabilitative care at your home or a rehabilitative facility.

Most beneficiaries do not pay Medicare Part A’s premium. You can be eligible for the $0 per month premium: if you or your spouse paid Medicare taxes for more than ten years. 

For 2022, Medicare Part A has a deductible of $1556 per benefit period. This covers you for the first 60 days as an inpatient in the hospital. After day 60, you have a per-day co-pay up to day 90. 

Medicare Part B

Senior patient getting prescription medicine from doctor in medical office at clinic.

Part B is medical care coverage. Covers durable medical equipment, outpatient medical services, and doctor visits. It includes any drugs you may get at the doctor’s office and mental health care.

Part A and B beneficiaries can visit any health care provider, specialist, or doctor that accepts Medicare. Some of those services include; flu shots, annual doctor’s visits for wellness, and screening for some conditions. Medicare Part B also offers free services in preventive care.

One essential thing to note is that Part A and B will not cover prescription drugs, vision, or dental coverage. The standard premium that you can pay per month for Medicare Part B is $170.10. However, eligible individuals with a higher income pay more premiums than those with a low income. The Medicare deductible involved in Part B is $233. After the deductible, you will need to pay for at least 20% of the doctor’s services costs.

Medicare Part C

An elderly woman with hearing aid

Part C also goes by the name Medicare Advantage plans. Private insurance companies are responsible for offering Medicare coverage. Part C is an alternative to Part A and B. Part C has different restrictions and prices than Original Medicare.

Medicare Advantage plans will cover medical and hospital care benefits. Another main benefit of Part C is that it covers aspects that the Original Medicare does not. For example, it can include coverage for dental, vision, and hearing, as well as gym memberships, transportation, and many other services.

Also, note that the premium for Medicare Part C varies. In most parts of the country, there are Advantage plans available for $0-20 per month, but in order to qualify for Medicare Advantage, you must continue to pay your monthly premium for Medicare Part A and Part B.

Medicare Part D

Private insurance companies are also responsible for Part D, which is coverage for prescription drugs. The private health insurance policies follow Medicare’s rules and regulations. 

The premium you need to pay for Medicare Part D varies. It depends on the plan you choose. However, the national premium average is about $33.37, but it can be higher. The plans you select can charge up to $480 in deductibles. Individuals with higher incomes pay higher premiums.

What are the Medicare Supplement Insurance Plans?

Your Guide to Finding the Right Medicare Coverage for You

Another essential aspect you should know about is the Medigap or Medical Supplement Insurance Plans. These plans are designed to fill the “gaps” in your Original Medicare out-of-pocket costs. 

Medigap plans are labeled Plan A all the way through Plan N, with the most popular plan being Plan G. Each plan covers a different amount of the Medicare out-of-pocket expenses.. 

When first starting Medicare Part B, you will have an enrollment period to choose any medicare supplement plan available in your area without having to answer any health questions to determine your eligibility. You are automatically accepted.

After your initial enrollment period, you will have to medically qualify in order to enroll in a Medicare Supplement plan. Conditions such as heart issues, diabetes with high insulin, and others can be declinable reasons for Medicare Supplements.

The amount you pay for a medicare supplement is determined by several factors including your age, zip code, gender, and smoker status. 

What Are Key Points to Take Away From Medicare Education?

The Original Medicare (Part A and B) only covers medical and hospital services. However, it does not cover prescription drugs, vision, or dental plans. However, if you need drug coverage, you can choose to include Part D as part of your plan. 

If you want an extra hearing, vision, or dental coverage, consider Part C. Make sure to prioritize your health care needs before choosing a plan.

The Medicare Family is here to help advise you on the right Medicare Plan. Contact us to learn more about the Medicare plans.

Sylvia Gordon, aka Medicare Mama®, is an expert on all things Medicare and Social Security. She is the 2nd Generation here at The Medicare Family and has served on the advisory boards of major insurance companies like UnitedHealthcare®, Cigna, and Anthem. In her free time, she can be found taking care of her animals (dogs, goats, peacocks, chickens), and reading a good book. Learn More.
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