What is Medicare?
Medicare is insurance offered to people that are 65 or older and to people that have certain disabilities. There are two parts to Medicare, Medicare Part A and Medicare Part B. Medicare Part A is what you use when you enter the hospital or a Skilled Nursing Facility. Medicare Part B is what you will use for your medical and Doctor bills.
How much does Medicare cost per month?
Most people will only have to pay a monthly premium for Medicare Part B. The current Part B Premium for most people is $121.80 per month.
What will I have to pay when I use Medicare?
Medicare Part A: When you go to the hospital you will have to pay the first $1,288.00 for each benefit period. When you enter a Skilled Nursing Facility, you will have to pay $161.00 per day starting day 61.
Medicare Part B: You will have to pay the first $166.00 per year for medical and Doctor bills, then Medicare will step in and pay 80% of your bills. Please note, that there is no max out of pocket for the 20% that you have to pay.
What are my coverage options for Medicare?
It may feel like you have a hundred different Medicare coverage options, however you really only have 2. All of those options fit into 1 of 2 types of coverages.
Medicare Advantage Plan
Medicare Supplement Plan (Also called a "Medigap Plan")
Every option that you are reviewing online, or getting plan information fits into one of the above, it is either a Medicare Advantage Plan or a Medicare Supplement Plan.
Understanding which type of coverage you want is the first step and it will make choosing your actual Medicare Plan much easier.
What is a Medicare Advantage Plan?
A Medicare Advantage Plan is not a Supplement Plan, it is a private alternative to Medicare. A Medicare Advantage Plan will not pay the bills that Medicare would normally pay, instead a Medicare Advantage Plan will charge you a different deductible, different copays and different co-insurance compared to Medicare.
Medicare Advantage Plan Summary:
Low monthly premium. (Sometimes advertised as $0.00 per month)
You will usually have to pay a fee every time you use the plan. ($15.00 copay for PCP visit, $300.00 per day each day you are in the hospital, etc…)
You have to go to certain Doctors, Hospitals and Providers. (HMO or PPO Network)
You will have to get prior authorizations for some procedures.
You will have to get referrals to go see a specialist.
What is a Medicare Supplement Plan?
A Medicare Supplement Plan will be the best coverage you have ever had in your life. If you go to the hospital your Medicare Supplement Plan will pay the $1,288.00 that Medicare does not pay. When you go to the Doctor, get lab work or even a surgery – Medicare will pay 80% and your Medicare Supplement Plan will pay the other 20%.
With a Medicare Supplement Plan, you will pay more per month but you are paying for:
Flexibility – You can go to any Doctor that accepts Medicare and you do not have to get prior authorizations for procedures.
Predictability – You know that as long as you pay your monthly premium, You will rarely have a bill that you have to pay. (My favorite Medicare Supplement Plan is G. With Plan G, all you pay is the Part B Deductible)
So which type of coverage is best for you?
Ask yourself this question: "If I chose a Medicare Supplement Plan, and I pay $120.00 per month, and I have a good year with my health, let's say I didn't really use the Supplement Plan that much – Would I consider that $120.00 per month a waste of money or becausej I am 65 or older, and I am more likely to use my health insurance in the next 5 years compared to the last 5 years, the $120.00 per month is a cost of living?"
Waste of money – If you chose a "waste of money", and you do mind being told what Doctors you can go too, then you are a "Medicare Advantage Plan person".
Click here for a guide on how to choose the right Medicare Advantage Plan.
Cost of living – If you chose "cost of living" then you are a "Medicare Supplement Plan person".
Click here to learn more about Medicare Supplement Plans. (Also called, "Medigap Plans")
This content is how I , Robert Bache "MedicareBob" explain Medicare. I do not work for Medicare, but If you want more specefic information you can contact me: Robert@SrHealthcareDiret.com or visit Medicare's website:
Medicare Part A: https://www.medicare.gov/what-medicare-covers/part-a/part-a-coverage-skilled-nursing-facilities.html
Medicare Part B: https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html
Medicare Advantage Plans (Medicare Part C): https://www.medicare.gov/what-medicare-covers/medicare-health-plans/medicare-advantage-plans-cover-all-medicare-services.html