Understanding Medicare Coverage: What is Best For You

Medicare is a federal health insurance program for U.S. citizens age 65 and over. Navigating the ABCDs of Medicare coverage can be overwhelming for seniors.

From Medicare A (also known as original Medicare) to Medicare B, C and D, it’s easy to quickly become overwhelmed by choices. But understanding each part of coverage is essential for you to make an informed decision about your health care options.

Here we will break down the basics of each option so that you can make an educated decision about your health care needs.

 

What is Medicare

Medicare is an essential program for seniors in the United States. This program helps cover a variety of medical costs, including doctor visits, prescription drugs, hospital stays, nursing care, rehabilitation services and home health care. It also covers services such as mental health counseling and preventive care to help seniors maintain their physical and mental well being.

Understanding how Medicare works is important for seniors as it can provide them with much-needed protection from unexpected medical costs. Furthermore, it is important for seniors to understand the differences between Medicare parts A, B and D so that they can properly use their benefits in order to get the most out of their coverage.

We asked Hadley Carmichael, owner and senior Advisor of Carmichael Insurance Group, for some guidance on how seniors can best navigate this sometimes confusing web of plans.

According to Carmichael, as of October 2021, the total Medicare enrollment is 63,964,675, with over half of seniors enrolled in the Original Medicare plan.

She knows that it can be difficult to know which plan is best for you, and helps her clients to understand the different options.

 

Original Medicare (Parts A & B)

“Everyone’s situation is different from health to finances.” says Carmichael.   “Be open to all options- both Medicare Supplements and Medicare Advantage Plans. What works and is great for someone, is not necessarily the right fit for you.”

That is why working with an experienced, local, Medicare broker is so important, like Carmichael and her Agency.

Original Medicare includes two parts: hospital insurance (Part A) and medical insurance (Part B).   Let's explore what this means.

 

Medicare Part A covers mainly hospital related medical care. Carmichael says it is important to know that “Part A will cover your inpatient hospital stay, inpatient rehab, skilled care, some home health care and hospice. Part A does NOT cover ANY preventative or durable medical equipment.”

 

Medical Insurance (Part B) is the second part of Original Medicare. It helps cover medically necessary services like doctor’s visits; outpatient care; preventive services; home health care; durable medical equipment; mental health care; ambulance services; laboratory tests; x-rays; surgical procedures; and more.

In addition to covering these types of treatments, Part B also helps cover certain immunizations that help protect against diseases such as measles, mumps, rubella, tetanus, diphtheria, pertussis and others that may be recommended by your doctor.

Carmichael points out an important fact that “Medicare Part A is free, and that Part B has a premium that is means tested, which means that you may pay more for Part B.”

 

Medicare Part C (Advantage Plans)

These plans combine original medicare parts A & B into one plan and often provide additional coverage such as prescription drug coverage through a single monthly premium payment. They are offered by private insurers that have contracts with medicare but they must follow certain rules set by medicare to offer these plans.

Generally speaking they offer more comprehensive coverage than original medicare but they may also come with higher out-of-pocket costs depending on the type of plan selected.

 

Medicare Part D (Prescription Drug Coverage)

This optional benefit provides prescription drug coverage through private insurers that have contracts with medicare. It helps cover both generic and brand name drugs prescribed by your doctor or other healthcare provider in order to treat a variety of illnesses or conditions from diabetes to high blood pressure among many others.

The cost of this coverage varies depending on which insurer you choose and which level of coverage you select - basic or enhanced - but generally speaking it helps lower your out-of-pocket costs for prescription medications so it can be worth considering if you take any regular medications prescribed by your doctor or other healthcare provider.

One tip that Carmichael gives is to “apply for Medicare A and B three months prior to your birthday month to avoid any holdups and or snags.”

 

Conclusion:  

Navigating the ABC&Ds of Medicare can seem overwhelming at first glance but understanding what each part covers will help make it easier to determine what kind of coverage is right for you based on your individual needs. From original medicare parts A & B to advantage plans (part C) and prescription drug coverage (part D), there are several options available so it's important to research all available options before making a decision about which one is right for you!

Our specialists at Simple Reverse understand that you have many things to worry about during your retirement years.  Not only is your health of great importance, but making sure that you have the necessary financial support to live a healthy lifestyle.  Schedule a call with one of our specialists to discuss the options you have for a secure financial future.