Medicare Made Simple
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 $134.00 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 $1,1316 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 $183.00 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 coverage.
- 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.
- Medicare Advantage Plan Summary:
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 $1,316.00 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 because 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 not mind being told what Doctors you can go too, then you are a “Medicare Advantage Plan person“.
Cost of living – If you chose “cost of living” then you are a “Medicare Supplement Plan person“.
This content is how I , Robert Bache “MedicareBob” explain Medicare. I do not work for Medicare, but If you want more specific information you can contact me: Robert@SrHealthcareDiret.com or visit Medicare’s website:
Medicare Advantage Plans (Medicare Part C): https://www.medicare.gov/what-medicare-covers/medicare-health-plans/medicare-advantage-plans-cover-all-medicare-services.html