Going on Medicare means leaving behind the headaches that can come with employer-sponsored medical plans or those you can purchase on the individual market. But Medicare comes with its own choices that can be daunting. What are all these parts, like part A, part B, and part D? What is Medicare Advantage, and how does that differ from Medigap?
Here at Kamm Insurance Group, we get that this can be confusing, especially when you first switch to Medicare, and we are happy to help.
What’s up with all these parts?
- Part A: This policy covers inpatient hospital stays, whether after a planned procedure or an illness or emergency situation. It can also cover hospice care and some skilled nursing and home health care.
- Part B: This covers outpatient care, such as doctor visits, preventive care, lab tests, imaging, and medical equipment.
- Part D: This policy covers prescription medications, including vaccines.
- Wait, where did part C go? Part C is what we now call Medicare Advantage, which are approved plans from private insurance carriers that replace the multiple parts of original Medicare with a bundled plan.
There are two ways most people access Medicare: original Medicare plans and Medicare Advantage. When choosing which coverage is right for you, consider:
Cost
- Original Medicare: You pay a monthly premium for Part B, along with your chosen policy’s deductibles, copays, and coinsurance. There’s no out-of-pocket maximum, but you can buy a Medicare supplement (Medigap) policy to help.
- Medicare Advantage: You pay your monthly Part B premium plus the Medicare Advantage plan’s premium (if it has one). These plans usually have an out-of-pocket maximum to cap costs, more like the employer-sponsored and individual market plans you had before.
Coverage
- Original Medicare: Covers services in most doctors’ offices, hospitals, urgent-care clinics, pharmacies, and other healthcare facilities. Services will be covered under part A, part B, or part D accordingly.
- Medicare Advantage Plans: Medicare Advantage plans must cover all of the services original Medicare plans do. Some also bundle in coverage for dental, vision, or hearing care.
Doctor and hospital choice
- Original Medicare: Original Medicare policies are accepted by most providers and hospitals. There are few network restrictions, so you’re unlikely to find a provider who won’t take your plan.
- Medicare Advantage: Here is the catch with Medicare Advantage. Most Medicare Advantage plans work on a more limited network, either like an HMO where you must stay in network to get any coverage at all, or like a narrower-network PPO, where you can get some out-of-network coverage, but it really pays off to stay in network. Not all doctors take Medicare Advantage plans, so if you’re considering this route, check with your nearby hospitals, your primary care physician, and any specialists you see to make sure they accept the plan before you buy.
It’s important to understand your coverage options and compare different coverage choices so you can get the coverage that’s right for you. Kamm Insurance Group has partnered with eHealth to allow you to easily compare and enroll in plans online. We understand, though, that you might still have questions, so don’t hesitate to reach out to us by phone or online.
Source: https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare
