Which Medicare Plan is Best for You? MemorialCare professionals can help you decide what works
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Medicare is a federal health insurance program that is available to U.S. citizens or permanent legal residents. Others eligible for Medicare are those with certain disabilities or conditions.
During the Annual Election Period, October 15 through December 7, individuals with Medicare can make changes in their Medicare plans and prescription drug coverage to better fit their needs - these changes take effect on Jan. 1, 2023.
“You may not want to change plans - and that is your prerogative. However, if your doctor notifies you that your health could worsen, or perhaps you are feeling a decline, it may be in your best interest to find a plan that will cover more of your procedures and preventative measures to ensure you get care in an efficient manner,” said Mark Schafer, M.D., chief executive officer of MemorialCare Medical Group.
Before making any decisions, however, it’s best to familiarize yourself with Medicare’s main components:
Original Medicare, or Part A and B
Part A and B of Medicare make up what is known as “Original Medicare,” covering medical services and supplies in hospitals, clinics or other health care facilities. Part A covers hospital insurance and Part B covers medical insurance and both are managed by the federal government through Original Medicare.
With Original Medicare, you are generally able to see a primary care doctor, specialist or hospital that takes Medicare in the county. You first pay a deductible, then Medicare pays its share while you pay the copayment for services and supplies. Since Part B covers more routine services and supplies, you are usually required to pay a monthly premium - it will average around $164.90 in 2023, but can change depending on your income.
Medigap
Medigap is Medicare Supplement Insurance that helps fill “gaps” in original Medicare. Original Medicare pays for most (but not all) of your health services and supplies. A Medigap policy can help you pay remaining health care costs, like copays, coinsurance and deductibles. But keep in mind that Medigap policies don’t cover things like long-term care, vision, dental or hearing aids.
Medicare Advantage, or Part C
Part C, or Medicare Advantage plans, are private insurance plans approved by Medicare that provide beneficiaries with Part A, B and D coverage. Not all Medicare Advantage plans are the same; make sure you compare the different plans available to you before joining.
In most cases, you’ll need to use doctors who are in the plan’s network, but plans may have lower out-of-pocket costs because of that. All plans cover the same services and supplies that Original Medicare Parts A and B offer, but in addition to this basic coverage, Medicare Advantage plans can offer extra benefits. Some of the additional benefits you may find in a Medicare Advantage plan include:
- Dental coverage
- Hearing coverage
- Vision coverage
- Over-the-counter benefits
- Adult daycare services
- Medical transportation
- Home safety devices
- Meal delivery
Medicare Advantage gives you access to these benefits within a single plan, making it a popular choice over Original Medicare coverage.
Medicare Drug Plan (Part D)
It is important to understand how your prescription drugs are being covered. Part D, or the Medicare Drug Plan, helps with the cost of prescription drugs. Many Medicare Advantage Plans include Part D, so it may be more cost-effective for you to find a Medicare Advantage plan that covers your prescriptions at no extra cost.
However, if you find that Original Medicare or a Medicare Supplement plan (Medigap) suits your needs, you can add a standalone Medicare Drug Plan. It is recommended that you still enroll in Part D as soon as you’re eligible - if you delay enrolling, you may need to pay a penalty. This can turn into a permanent cost added to your Medicare Part D premium for as long as you use Medicare. Part D premiums vary depending on filing status and income.
Annual Election Period
The time is now to decide on next year’s coverage. From October 15th to December 7th, you can shop for and compare plans. You can join a Medicare Advantage plan or enroll in a Part D plan, or switch between Original Medicare (Parts A and B) with or without a Part D plan and a Medicare Advantage Plan.
It’s the right time to review your current Medicare health and drug coverage so you can make changes depending on how satisfied you are with your coverage for next year at memorialcare.org/Medicare. Jose Juarez is a Medicare Education Specialist at MemorialCare Medical Group (jjuarez2@memorialcare.org). He has many years of experience speaking to seniors and educating them about the basics and intricacies of navigating Medicare, finding the best plan for them, and encouraging them to take advantage of the programs and plans available to them.