U.S. senior citizens (65 years+) and certain people with qualified health problems and/or certain permanent disabilities are compensated with Medicare health insurance by the government. With multiple Medicare plans to choose from, trying to choose the best health care plan can get tricky. See our top things you should know about your Medicare plans in order to find the right health benefit package for you.
One choice is Original Medicare (or Traditional Medicare), providing coverage in Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
Most hospitals and physicians in the U.S. accept Medicare (as long as they accept reimbursement for covered services at a Medicare-approved amount). You will pick your own physician from a wide network under Original Medicare.
Original Medicare provides medical services deductibles, copays, and co-insurance with no annual expense limit for the senior. Original Medicare does not have prescription drug coverage above the prospective high price.
Instead of Orginal Medicare, you could select a Medicare Advantage Plan. These plans may differ in their offerings, and a private company approved by Medicare offers health benefits.
Medicare Advantage Plans cover all of Original Medicare's benefits and can also cover those programs not included in Original Medicare like vision, dental, hearing aids, and more. Medicare Advantage plans will greatly reduce medical service copays & coinsurance and provide a maximum out-of-pocket (MOOP) on insured costs that can be charged by beneficiaries in any given year. Many plans provide coverage for prescription drugs, but some plans may require you to buy this separately as Medicare Part D
The medical providers you may see for covered services are also limited by Medicare Advantage Plans. The place can also be a downside, as in metropolitan areas, MA plans are typically more accessible.
Medicare Part D is coverage for prescription medications from Medicare that can be purchased individually or included in a Medicare Advantage Plan as a Stand-Alone Prescription Drug Plan. Part D, similar to Medicare Advantage Plans, is administered by Medicare-approved private businesses and meets Medicare-set laws.
Private companies offer Medicare Supplement Insurance or Medigap policies that may help pay for some of the health care expenses not covered by Original Medicare, such as copayments, coinsurance, and deductibles. Some Medigap policies often provide coverage for programs that are not provided by Original Medicare, such as medical treatment while traveling outside the U.S. Medigap insurance plans are standardized, although they will differ on where you live.
For Medicare Part B, there is a monthly fee that is adjusted by Medicare each year that must be charged by all beneficiaries who want to participate in either Original Medicare, a Medicare Advantage Plan, or a Medicare Supplement Plan. There is an annual fee that varies by plan and place for all Stand-Alone Prescription Drug Plans and Medicare Supplement Insurance Plans. Medicare Advantage plans can have an extra monthly fee, however, depending on the exact plan and venue, others are available as low as zero dollars.
The best way to find the right Medicare plan is to analyze your current health and budget, project programs that you expect you will need in the future, and settle on a plan that integrates all at a fair price. Comparing the out-of-pocket expenses you would incur, including deductibles, coinsurance, and copayments, is important. Higher premiums, while unattractive at first sight, may mean lower out-of-pocket expenses.
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