Medicare is a great initiative that helps the aging community pay for their various medical needs as they enter the golden years. The coverage helps offset the costs of check-ups, hospital visits, and more.
While Medicare is a fantastic resource for people 65 years of age and older, as well as a few younger people with disabilities and chronic diseases, it can be complicated to navigate and set up. Despite the many benefits, Medicare has gaps that leave seniors vulnerable.
Here’s everything you need to know about getting the most out of your Medicare coverage and using supplemental insurance to fill the gaps.
What You Need to Know About Medicare
At a glance, the Medicare system can be overwhelming. As a result, people often make the easiest choice possible without comprehending what they’re agreeing to. This can create dangerous gaps in coverage that cause severe problems down the road.
Medicare is broken into four key components, also known as Part A, Part B, Part C, and Part D.
Part A – Hospital Coverage
Part A explicitly covers hospital coverage, which could include inpatient procedures and specialized nursing facility care. Part A is always included in Medicare.
Part B – Medical Coverage
Like Part A, Part B is also always included in the core Medicare offering. That being said, the title is somewhat ambiguous. What do they mean by medical coverage? In a nutshell, Part B covers visits to the doctor, outpatient procedures, and diagnostics.
Part C- Medicare Advantage
Part C is where things get a little tricky. Medicare Advantage plans are privately owned insurance offerings that have been approved by Medicare. They must include everything from Parts A and B, and often cover extras as well. For example, dental, optometry, and hearing specialists.
There are pros and cons to Medicare advantage. On the one hand, Plan C has lower premiums than general Medicare. However, there are often higher co-pays and market restrictions to consider.
Plan D – Drug Coverage
D is for drug coverage when it comes to Medicare. Plan D is only available through private providers and covers the cost of medication.
What Supplemental Coverage Covers
Many people make the mistake of thinking that supplemental coverage — often referred to as Medigap — will add Plan D to basic MediCare coverage or perform more like a Plan C program.
This assumption is incorrect.
Supplemental coverage pertains to costs specifically left out in Medicare coverage, such as co-pays and deductibles. It will not automatically add vision or hearing coverage, nor will it add drug coverage.
When you get supplemental health insurance for seniors, you pay your basic premiums as well as a premium to the third-party provider of additional coverage. It’s important to know that the policy only covers one person; if you need coverage for your spouse, it will be a separate policy.
Who Should Get Supplemental Coverage
For some, it can seem like supplemental coverage is a waste of time. It’s essential to look at how co-pays and deductibles can add up. If you have any debilitating health issues, which become more common as you age, the supplemental coverage can make a significant difference.
Consider this: if your Medicare covers 80%, you’re left with 20% of the bill. At 65, you may be in good health and could still be working full-time if you choose to do so. If you have $20,000 in medical bills, that’s $4,000 out of pocket in co-pays, co-insurance, and deductibles.
As you get closer to 70, your health may start to flag. You reach retirement and have a smaller income to work with. If your medical bills go up to $30,000, you now have to pay $6,000 out of pocket. That’s where Medigap insurance saves the day.
The best way to know if you need supplemental coverage is to crunch the numbers. Estimate your current out-of-pocket expenses versus your potential supplemental coverage premiums and make a decision based on the outcome.
Tips for Getting the Most of Your Medicare
Whether you stick with the basic coverage or opt for the added protection of supplemental coverage, there are things you can do to get the most of your plan:
- Sign up early – if you’re 64, now is the time to get your paperwork in order and submitted so that Medicare kicks in the day you turn 65, and you avoid costly delays.
- Use special enrollment – if you work past 65 and have a health coverage plan through your employer, be sure to use the special enrollment period when you retire to avoid coverage gaps.
- Use “Welcome to Medicare” – as a part of the Medicare onboarding package, you receive a free wellness check-up. Use it to your advantage and be proactive in your health. There are also other preventative health offerings, such as bone density scans, that have no out-of-pocket fees associated.
- Budget your co-pays and premiums – remember to account for these fees in your retirement budget.
By choosing the right coverage and ensuring that you’re proactive in caring for yourself, you’ll get the most value possible from Medicare.
