In the vast landscape of healthcare, few decisions are as significant as those related to Medicare. This federal program was designed to provide health coverage in most cases to individuals aged 65 and older, and those under 65 who have a qualifying disability. Whether you’re on the brink of Medicare eligibility or looking to assist loved ones, it demands thoughtful consideration and informed choices. This guide aims to demystify the journey by exploring essential aspects, including the choice between Medicare Supplement and Medicare Advantage plans, prescription drug coverage, and access to things that are important to you as the patient, such as chiropractic services.
Original Medicare, which was created in 1965 to cover hospital and medical insurance, leaves gaps in coverage such as deductibles, copays, and coinsurance often leading to unexpected healthcare costs. As you get ready to enroll in Medicare, you’re presented with two primary choices to cover these gaps. You can choose a Medicare Supplement plan (also known as Medigap) or a Medicare Advantage plan (also known as Part C.) Let’s delve into the key differences:
1. Medicare Supplement Plans (Medigap) – These private plans work alongside Original Medicare (Parts A and B) and help cover gaps in coverage, such as deductibles, copayments, and coinsurance. They offer a sense of predictability in healthcare costs and the freedom to visit any doctor or specialist who accepts Medicare without a referral.
2. Medicare Advantage Plans (Part C) – These private insurance plans replace Original Medicare and often include additional benefits, such as dental, vision, gym memberships, transportation, acupuncture, prescription drug coverage, and many other services. These plans typically require that you choose a primary care physician, and use their network of healthcare providers, limiting your options to in-network doctors and hospitals.
When considering your Medicare coverage, you will also need to factor in your prescription drug coverage, known as Medicare Part D.
Part D plans are purchased as a standalone plan to pair with a Medicare Supplement or can be included in your Medicare Advantage Plan. Some key things to consider when picking your drug coverage will come down to the plan’s formulary. Each Part D plan has a list of covered medications called a formulary. You will want to make sure your prescription drugs are covered in the plan you are choosing.
Choosing between Medicare Advantage and a Medicare Supplement plan depends on your individual needs, preferences, and budget. As a local independent insurance agent, I review the plans available in your area to find the right fit for your healthcare needs.
As your personal agent, you will have access to my services year-round and I will review your coverage every Annual Enrollment Period (which occurs from October 15th – December 7th) to make sure your Medicare Advantage or Stand-Alone Prescription drug plan is still the right fit for you year to year.
Your health matters and I’m dedicated to helping you make the most of your Medicare journey. Whether you choose to work with me or not, I highly recommend working with an independent agent who can get into the details of the brief overview I have given here.
Here’s to your well-being and well-informed choices,