Once you have Medicare Part A and Part B, you can now consider your options for additional health coverage under the Medicare system.
Traditional Medicare is sometimes preferred by Doctors and Hospitals for a couple of reasons. One is ease of use. With traditional Medicare, there are fewer pre-authorization requirements. Reimbursement rates are sometimes higher than with other Medicare plans.
For individuals with Medicare, it is important to know that with traditional Medicare, there are deductibles and copays for using part A and part B. Also, Medicare only pays 80% of the costs. You are responsible for paying the other 20% as a copay. If you go to the doctor, your 20% will be less than if you have a hospital stay and must pay 20% of that expense.
Consider carefully if you can pay 20% of a hospital stay that was billed for $10,000, $50,000 or even $100,000.
You must also pay for a Prescription Drug Plan (PDP) to avoid getting a late enrollment penalty from Medicare. The national average for PDPs is about $48 per month.
A good option to keep traditional Medicare and possibly avoid paying the deductibles and 20% copays is to buy a Medicare Supplement.
Supplements range in prices from $100 to $200 per month for those turning 65. You can qualify for “Guaranteed Issue” when you turn 65 or when you lose employer coverage. This allows you to get the best prices and have no worries about pre-existing conditions.
The Supplement will pay most or all of the 20% you will owe, and some will pay most of your deductibles as well.
You will also need to buy a Prescription Drug Plan to help pay for your medications and avoid a late enrollment penalty.
Option Three is to choose a Medicare Advantage Plan. Most Medicare Advantage plans have low or no monthly premiums. These plans take the place of Medicare Part A, Part B and a Prescription Drug Plan.
There are often no deductibles, and you only pay copays when you use the benefits.
Depending on the plan, you may also get Extra Benefits like dental, vision, hearing, gym membership and many others.
You will need Pre-authorization for some services.
Each option has great benefits, and you get to choose for yourself. If you need help sorting through the details of your circumstances, please talk to a licensed, certified Agent or Broker.
This article is for information only and should not be considered a recommendation. Talk with a licensed Health Insurance Professional about your specific circumstances. For more information you can go to The Texas Department of Insurance.
