If you’re new to Medicare, you should know
that not all Medicare plans work the same way. Medicare Advantage plans
(Medicare Part C) are different than Original Medicare (Parts A and B) plans.
Whether you want the flexibility of a PPO or the predictability of an HMO, you
should learn the difference before purchasing Medicare so you know exactly what
you’re getting. The following can help you decide which plan is best for you
based on your lifestyle.
Medicare Part A
Medicare Parts A and B are known as Original
Medicare, and Part A covers things like hospital visits and check-ups. Part A
also covers hospice care, some in-home care, inpatient hospital stays, and
skilled nursing care. Once you get Part A, you may have to pay a premium;
however, most people don’t. That’ll all depend on whether you (or your spouse)
paid taxes into Medicare when you were working. If neither of you did, you can
simply buy Medicare Part A. The standard premium for Part A is about $252.
Medicare Part B
Medicare Part B covers outpatient care and
preventative care, such as flu shots, Hepatitis B shots, pneumococcal shots,
yearly wellness exams, mammograms, and screenings for cardiovascular disease,
cervical and vaginal cancer, prostate cancer, diabetes, glaucoma, sexually
transmitted infections, and colorectal cancer, among other things.
Other preventative benefits include intensive
behavioral therapy for obesity, smoking and tobacco use cessation counseling,
diabetes self-management training, and medical nutrition therapy for people
with diabetes or renal disease. It also covers outpatient services, tests and
X-rays, doctor visits, and medical supplies. The standard premium
for 2020 is $144.60 and
you’ll likely pay $198 for your premium, according to Medicare.gov.
Medicare Part C
Medicare Part C is also known as a Medicare
Advantage plan, and it’s an alternative to traditional Medicare coverage. It is
available from private, Medicare-approved insurance companies. The most common
types of Medicare Advantage plans include Private Fee-For-Service (PFFS),
Preferred Provider Organizations (PPOs), and Health Maintenance Organizations
(HMOs). Other types of Medicare Advantage plans include Provider Sponsored
Organizations (PSOs), Special Needs Plans (SNPs), and Medical Savings Accounts
(MSAs).
If you have Medicare Parts A and B and you
live in the plan’s service area, you can also apply for Medicare Part C. A lot
of Medicare Advantage Plans provide prescription drug coverage (Part D) as
well. The cost you’ll pay for Part C varies by provider and location.
Medicare Part D
Medicare Part D was created by the federal
government to help reduce the cost of retail
prescription drugs for
recipients. If you want to apply for Part D, you’ll have to apply through a
private insurance carrier instead of through the Social Security office. Plans
will differ based on where you live, which means not all plans are available
everywhere. With Medicare Part D, you’ll be required to pay an insurance premium
to your insurance provider, and you’ll get lower copays on your medications.
The cost for 2020 is $32.74 per month. If you plan to enroll in Part D, you’ll
need to follow the rules regarding when you can apply.
How to Choose the
Right Plan
Choosing the right Medicare Advantage plan
starts with determining your individual needs and evaluating the insurance you
might currently have. Other factors that might come into play include cost,
whether you need prescription drug coverage, and what’s included in each plan.
There’s a lot that Medicare alone doesn’t
cover, which is why companies like Anthem have plans that enhance your
coverage. These kinds of plans can help you pay for the things that Original
Medicare won’t cover. Comparing
Medicare Advantage Plans means taking a look at what each plan has to offer, and
learning the difference between PPO and HMO coverage is also important so that
you can make the right decision for your lifestyle.
Now that you have an idea of what each plan
includes and the associated cost, you can make the right choice so you can live
a happy, healthy life throughout your retirement years. Getting all of the
information you need and comparing plans is the first step in making an
informed decision when it comes to your health.
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