Here are Seven Things you should consider when choosing a Medicare plan.
Cost
Coverage
Any other Coverage
Prescription Drugs
Doctors and Hospitals
Quality of Care
Travel
Let’s look at the First two, Cost and Coverage, in this blog. We will look at the next two in the next blog.
Costs. Original Medicare has a deductible of $1556 for Part A. So, if you go into the hospital overnight, they will charge you $1556 regardless if you are in the hospital for one night or 30 nights. This deductible is per benefit period. The benefit period starts when you enter the hospital and ends when you are out of the hospital or skilled nursing for 60 consecutive days. If you are in the hospital multiple times during the year you could be billed multiple times for $1556.
Medicare part B has a deductible of $233 per year. Once this deductible is paid Medicare will begin coverage at the rate of 80% paid by the government and 20% paid by you. Part B for most people will cost $170 per month. There is an income related adjustment if for a single person your tax reported income is over $91,000. For joint filers the tax reported income level is $182,000.
An important note for Original Medicare is that there is not a dollar coverage cap per year for the 20%. That is the patient’s responsibility.
Medicare Advantage plans (Part C) have an annual cap on Medical Expenses in an amount generally from $3000 to $10,000 depending on the plan and company you choose. In this plan you will have co-pays for medical services and hospital stays but once you reach an out-of-pocket dollar contribution that hits this above-described cap you will pay nothing for the balance of the year.
Then there is a Medicare Supplement that will cost you an extra dollar amount in addition to the $170 per month that you will pay for the part B premium. Approximate costs at age 65 is from $125 to upwards of $170 depending on gender, plan and Company. This Supplemental coverage is purchased from private companies contracted with Medicare. You cannot have a Supplement along with a Medicare advantage plan. This secondary coverage will pay your 20% portion of Part B and generally deductibles. This eliminates your co-pays for doctors and hospitals. The key here for Supplements is that if Medicare pays for medical services, then the supplement will kick in and pay their portion.
When it comes to costs keep in mind that Medicare looks at coverage that is considered medically necessary.
Coverage
Under original Medicare you are permitted to see any doctor or hospital in the United States as long as they accept Medicare. This is an attractive feature of original Medicare if you want to travel but don’t lose sight of the costs associated with original Medicare.
Coverage under a Medicare advantage plan (part C) requires you to use a local network of doctors and hospitals. Advantage plans must cover all the services that original Medicare provides and some additional services such as Vision, Dental and Hearing. If you travel this advantage plan will cover you on an emergency basis.
Coverage under a Medicare Supplement plan will allow you to use any doctor or hospital across the United States as long as they accept Medicare. Remember that this Supplement plan works with original Medicare.