Provide me with the insurance coverage I need to secure my future well-being.
You may be approaching 65 and eligible to sign up for Medicare for the first time. You may be reconsidering your plan(s) for next year, intending to reduce your out-of-pocket costs or improve your coverage to include any change in your anticipated needs. Perhaps you are concerned that an elderly acquaintance or relative has asked for assistance making these choices.
In any of these circumstances, it makes sense to call on the expert advice of a trained, experienced Medicare specialist.
For some seniors, a combination of Medicare options A, A+B, C (ADVANTAGE PLANS), and D (PRESCRIPTION DRUGS) can provide the medical coverage they will likely need.
But, of these options, only Part A (in-patient/hospital coverage) is ‘free’; even then, you will have a deductible ($1556 for each hospital stay of up to 60 days and, after that, a daily coinsurance payment). There is no upper limit to the amount you could be charged.
You must have enrolled for Medicare Part A to enroll in Part B (medically necessary services). Essentially, this means doctor’s visits and most parts of outpatient care, including:
- Limited outpatient prescription drugs
- Ambulance services
- Outpatient surgery
- Preventive services, e.g., flu jabs, vaccines, cancer screenings
- Durable medical equipment (DME), e.g., walking frames
- Physical/occupational therapy and speech-language pathology services
The Medicare Part B monthly premium (for 2024)) is expected to be around $180 monthly, and the deductible to be $233 yearly. Medicare agrees the amount payable for each of the insured services. The beneficiary pays 20% for the medical services from participating providers. Remember, not all providers accept Medicare. The combination of Parts A and B is collectively known as the “Original” Medicare. Part D is an ‘outpatient ‘prescription drug benefits available to Original Medicare enrollees.
All These federal health insurance schemes are authorized and administered by the CMS (Centers for Medicare and Medicaid Services). CMS decides the services (and the medications/drugs) that will be covered, the monthly premiums, and the annual deductible.
The CMS also recognizes that individuals should be free to choose their preferred insurance provider AND the risk they are ready to accept.
Medicare Advantage plans, offered by private insurance companies, allow anyone who qualifies for Medicare to obtain the health insurance that best meets their needs from the insurance provider of their choice. Advantage plans must offer at least the same coverage as the ‘Original’ Medicare, i.e., Parts A+B. They may include prescription drug benefits and offer a wider choice of networks.
Suppose you are planning how you will deal with your healthcare needs for the future. The first thing you should do is enroll in Medicare Part A. That will cover you if you are hospitalized but expose you to the enormous costs of an extended stay or an uninsured procedure. After that, you have choices.
Supplemental health insurance policies can provide more protection beyond that which is provided by your primary (Medicare) insurance plan. Supplemental plans can improve medical coverage or limit out-of-pocket expenses, deductibles, co-payments, and coinsurances. They can cover services not included by Medicare, e.g., dental care, vision, or long-term care.
According to the 2023 Medicare Trustees Report, Medicare provided health insurance for over 57 million people aged 65 and older. During 2022, nearly 60% of Medicare beneficiaries supplemented their plans with private insurance.
Discussing your circumstances with an experienced Medicare specialist before making your choices makes sense.
