Our thanks to Danielle Kunkle, for this contribution to our blog.
Though Medicare has been around since 1965, there are changes each year that affect your premiums, copays and deductibles for the next year. Sometimes there are also legislative changes that can impact your benefits. Let’s look at an overview of Medicare for 2019.
Medicare Has 4 Parts
Original Medicare includes Part A hospital benefits and Part B outpatient benefits. You enroll in these two parts via the Social Security office during your Initial Enrollment Period which begins 3 months before your 65th birthday month. Part A covers inpatient hospital, hospice and skilled nursing. Part B covers most other medically necessary services on the outpatient sides, such as doctor visits, lab testing, emergency care, physical therapy, chemotherapy and much more.
In1997, the Balanced Budget Act also created Part C, which is the Medicare Advantage program, which we’ll discuss more below
The most recent part of Medicare is the voluntary prescription drug program that we call Part D. This will help to reduce the cost of your retail prescriptions.
Medicare Doesn’t Cover 100% of your Costs
Although Medicare covers the majority of your healthcare expenses, you are responsible for some cost-sharing. This includes deductibles, copays, and coinsurance. On the outpatient side, Medicare only covers about 80% of your covered procedures, and you are responsible to pay the other 20%. For this reason, most people enroll in additional coverage to help them with their cost-sharing. There are two primary types of supplemental coverage: Medigap Plans and Medicare Advantage Plans.
Medigap plans are also known as Medicare supplements and these plans pay after Medicare. In most states, you can choose from one of 10 standardized Medigap plans. These plans allow you to treat with any Medicare provider nationwide and you don’t have to choose a primary care doctor.
Since Medigap plans don’t include outpatient drug coverage, you would enroll in a standalone Part D drug plan as well.
Medicare Advantage plans (Part C) is optional coverage in which you can get your Medicare Part A and B benefits through a private insurance company that offers a network of providers. These plans often have lower premiums than Medigap plans but you’ll pay copays at the time of service for various medical services.
Between Medicare and the right supplemental coverage, you can rest assured your benefits will cover you well without breaking the bank.