The Best Medicare Plan for You: 3 Tips to Choose

Medicare continues to provide health insurance coverage for millions of Americans. As of 2022, 18.5% of the population is under federal insurance cover.

Medicare has been around since 1965. It has provided medical relief for those 65 years of age and above. Its scope further expanded to care for younger demographics. But, they must be dealing with specific health issues. They must also, within the past two years, have been receiving Social Security Disability Insurance.

Medicare disease covers include Amyotrophic Lateral Sclerosis (ALS) and End-Stage Renal Disease (ESRD).

Our article shares tips on how to choose the best Medicare plan.

Start With Clarity on the Different Plans

A 2021 report shows some interesting insights. Up to a quarter of Americans in the Medicare age bracket do not understand the different plans. True, they may know about Medicare, Medicare Advantage, and Medicare supplement plans. But, the level of knowledge is very basic, if at all.

The first step to choosing the right plan is to educate yourself on the Medicare plans. You have two broad categories.

Original Medicare

Original Medicare has Part A and Part B.

Part A is free for Medicare recipients and covers hospital stay-related costs. These include nursing care, home care, and hospice care.

Medicare Part B covers preventive and outpatient services. It will also take care of costs related to lab work and doctor visits. Please note you will contribute by paying premiums towards the plan.

As of 2022, the standard cost is$170.10. But you could pay more under the IRMAA or Income Related Monthly Adjustment Amount. The government will make automatic deductions from those who receive social security. The same applies to money coming in from the Railroad Retirement Board and The Office of Personnel Management.

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Medicare Advantage

Medicare Advantage or Medicare Part C only started in 1997. Medicare Advantage Prescription Drug Plan is also available under this. Medicare Advantage does not fall under the federal program. Rather private insurers offer the medical covers. But, only as long as Medicare approves the private insurance company. You must also qualify for Medicare A and B.

It allows users to take advantage of Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs). Patients get medical and hospital cover. Medicare Part D covers prescription plans and Medigap of Medicare Supplement.

Medicare falls under the Center for Medicare and Medicaid Services (CMS) mandate. It is a federally regulated program that applies the same across the entire country. So, even if you apply for Medicare in Texas, you get the same benefits as any other qualifying recipient.

To apply for the Medicare plans in Texas, you need to fulfill the same eligibility criteria.

Look At the Scope of Coverage

The scope of coverage ties in with our point above. But, go a little deeper with some research. It is critical to know what Medicare does not cover. There are significant gaps under Medicare Plan A and B.

It explains why the supplementary plans have become so popular. Still, it does mean that they do not have their disadvantages.

Original Medicare does not pay for:-

• Outpatient prescription drugs
• Long-term patient care
• Co-pays and deductibles. As of 2022, the Part a Medicare deductible is $1,556, up from $1,484 in 2021
• Dental care for tooth extractions, visits, dentures, fillings, and cleaning. You can get some cover under Medicare Advantage, but with a cap. Find out what your limit is before appending your signature on any documents
• Routine visual care. The exception is when going for eye exams after surgeries or diabetes complications
• Hearing aids or exams
• Overseas medical care. Under original Medicare, you get coverage anywhere within the US, but not outside. Do check what is available under Medicare Advantage. Some plans will not cover you abroad.

Medicare Advantage comes in to plug the coverage gaps. But, there is some disturbing news emerging about some insurance companies. They are denying or delaying patients’ relevant care. This is common when they feel the patient would have received reasonable care under Medicare Plan A and B.

There are calls by industry stakeholders for tighter regulation of the insurance providers. That will be the only way to reign in rogue underwriters.

Read more: Why Do Elderly People Need Individualized Pharmaceutical Care in 2022?

Cost Implications and Other Considerations

Research the cost implications of the covers you choose. As we stated, under Medicare Part B and Medicare Advantage you must make premium payments. Consider it your contribution to the insurance cover. But, that doesn’t scratch the list of the other considerations you should have in mind. These include:-

• An annual limit to out-of-pocket expenses. There is, for instance, no limit to out-of-pocket expenses under original Medicare. The same does not apply to Medicare Advantage. Once you reach the limit, you will no longer be liable for any costs falling under covered services within the rest of the year.
• Deductibles and Co-Pays
• Physician and prescription drug coverage. The best way to go about this step is to anticipate the year ahead. Take stock of all the medication you take. Also, determine which ones you are most likely to continue to take. You also know your doctor visits routine.
• All these are critical considerations when deciding the plan to choose. If your prescription drug use is higher, then Medicare Plan D would be a good option worth paying for.
• Will your present doctor accept Medicare coverage? Some may not, meaning you must look for new healthcare providers.
• Know the pharmacies and hospitals that accept Medicare. Learn all you can about the quality of care the physicians or hospitals offer clients. You can find a lot of information online by reading reviews or checking ratings.

Final Thoughts

Healthcare concerns for the elderly should be a thing of the past, thanks to Medicare. The best way to choose the best Medicare Plan starts with having proper knowledge of the covers. From looking at this article, it is clear that there is a lot to know. But as a beneficiary, you will appreciate taking the time to educate yourself.

There is a lot to learn. You will, for instance, note that Original Medicare does not cover prescription drugs. In that case, Medicare Advantage or Medicare Plan D would be worth considering.

Shop around and speak to Medicare insurance providers to see if they have what you need. We have shared salient points above that will start you off on the right path.