By Rhonda Jackson, Community Health Advocate, Finger Lakes Community Health
Overview of Medicare
Medicare is for people 65 or older (and some individuals under 65 who are disabled, blind, have ALS, or End-Stage Renal Disease). If you are about to turn 65, no doubt you are thinking about signing up for Medicare, along with friends and loved ones around your age. It’s an American rite of passage. Sorting through Medicare coverage options can be very confusing. Let’s take a look at your coverage options, so you can decide what Medicare program is best for you.
Medicare Coverage Options
The two main Medicare programs are Original Medicare and Medicare Advantage.
Original Medicare—the original plan with different parts
Most people are automatically enrolled in Original Medicare once they turn 65. People with Original Medicare receive their services through the traditional fee-for-service program which is offered directly from the federal government. Original Medicare covers 80% of costs, and you are responsible for the other 20% out of pocket. Many providers accept Original Medicare, but it does not cover most dental and vision.
Medicare Part A, Part B, and Part D
These three parts make up Original Medicare. Part A covers inpatient hospitalization, Part B covers outpatient costs like doctor office visits and lab work, and Part D covers prescriptions. Most people pay a monthly premium and/or annual deductible for all three parts. It’s important to enroll in all three parts when you first become eligible in order to avoid a late enrollment penalty. The late enrollment penalty is based on the length of time you delayed enrollment.
Medicare Part D coverage costs vary by plan. It’s important to choose a Part D plan that covers all your prescriptions. We can look at that with you to help compare the options and make an informed choice.
Medicare Advantage—bundled coverage
With Medicare Advantage or Part C, all of the different elements are bundled together for you—from prescriptions to doctors to hospitalization. Medicare Advantage plans are offered through private insurance companies that collaborate with Medicare.
For people with Medicare and Medicaid, Medicare Advantage plans offer Dual Complete plans which combine the two plans into one. These plans offer additional benefits such as dental, vision and over-the-counter benefits that you may not get with Original Medicare and Straight Medicaid.
You can enroll in a Medicare Advantage plan when you first become Medicare eligible or during the Medicare open enrollment period which occurs from October 7 through December 15. If you want to switch back to Original Medicare, you can do so between January and March of each year.
Original Medicare vs Medicare Advantage
Choosing between Original Medicare or enrolling in a Medicare Advantage Plan can be difficult. Here are some things to consider before deciding. With Original Medicare, you can see any doctor that takes Medicare, you do not need a referral to see specialists, and you will need to enroll in a Part D drug plan. You will pay 20% co-insurance for most Medicare-covered services after meeting your deductible and there is no out-of-pocket limit. With Medicare Advantage Plans, you typically need to see doctors who are part of their network and may cover additional services such as dental, vision, and hearing aids. Medicare Advantage Plans have an out-of-pocket limit in which plans must pay the full cost of your care after you reach the limit.
Medicare Savings Program
The Medicare Savings Program (MSP) helps you to pay Medicare costs if you have limited income. MSP helps eligible recipients pay their Part B premium, which this year is $164.90, and cost-sharing. Additional benefits include: the elimination of the Part B late enrollment penalty, and automatic enrollment in the Extra Help program, which lowers prescription drug and premium costs under Medicare Part D. If you are not eligible for MSP, you might still be eligible for Extra Help.
Questions? Help is here.
No matter your circumstances, it is best to enroll in Medicare as soon as you are eligible to avoid penalties for late enrollment. And there is much to prepare for, like making sure your current doctors and specialists accept your new coverage (Finger Lakes Community Health accepts Medicare enrollees, for instance).
With so many decisions and preparations around Medicare, everyone can benefit from a friendly conversation with an expert who works outside the health insurance field. That is why we are here. Talk to a Community Health Advocate to learn more about Medicare and discuss your options. You can reach one at organizations like Finger Lakes Community Health. Office for the Aging also offers help with Medicare enrollment.
We will take a look at your situation—in strictest confidence—and help you get started.
If you would like to find out more, call 888-614-5400, email or contact me (Rhonda Jackson) directly at 315-399-6357.
