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.
    1. Medicare Advantage Plan
    2. 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 $1,316.00 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:

  1. Flexibility – You can go to any Doctor that accepts Medicare and you do not have to get prior authorizations for procedures.
  2. 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“.  

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 specific information you can contact me: Robert@SrHealthcareDiret.com or visit Medicare’s website:

Sources:

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