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Untangling the Various Parts of Medicare, Medigap, and Medicare Advantage
Growing older has its share of complexities, and for many older adults, Medicare and its various components rank at the top. The terminology, enrollment dates, and different parts can leave you frustrated and confused about your coverage. Here’s what you need to know so you can make sure your healthcare needs are met.
Learn the lingo
Medicare is typically divided into four parts that are labeled A through D. Parts A and B are often called “Traditional Medicare” or “Original Medicare.” Basically, Part A covers hospitalization, and Part B is for outpatient services. Those two parts are through the government. Parts C and D are through private insurers approved by the government, and are meant to help fill in healthcare expenses not covered under Original Medicare. Part D is specifically for prescription drugs, while Part C covers a variety of health-related expenses.
Part C is where Medigap and Medicare Advantage come into play. Medigap works in conjunction with Original Medicare. Medicare Advantage is separate from Original Medicare, but covers all the same expenses as well as some additional ones, such as vision care, dental exams, and prescription drugs. Medigap is accepted by physicians who accept Medicare, and Medicare Advantage is network-based. When choosing between Medicare Advantage and Medigap, some experts suggest comparing the various options directly with your personal medical needs.
In addition to the four parts, it’s also important to become familiar with other terminology associated with Medicare. For example, those enrolled in Medicare are referred to as “beneficiaries,” and a “carrier” is the insurance company that would pay Part B medical bills. You can refer to this guide when words and phrases come up and you aren’t sure what they mean.
What does it cost?
Original Medicare is somewhat set as far as how much you pay. Part A is free to those who worked for 10 years or more and paid Medicare taxes. Those 10 years are calculated by the quarter, so if your work history was spotty, it needs to total 40 quarters. You still have a deductible, however, and it’s set at $1,364 for 2019. Modern Healthcare explains most people pay $135.50 for their 2019 Part B premiums, although this is computed by your income and higher earners will pay higher premiums.
Costs for Parts C and D depend upon your selections. Part C has numerous options and costs will vary greatly. Also the plans have copayments and coinsurance. Some experts suggest average monthly premiums for 2019 will be $28 for Medicare Advantage, and some statistics indicate most people paid $34 per month for Part D in 2018. If you have prescriptions you take, it’s important to check that plans you are considering cover those drugs, otherwise your costs will be out-of-pocket.
When are the enrollment dates?
At age 65, you become eligible for Medicare benefits. Verywell Health points out that unless you enroll in Medicare, you will forfeit your Social Security benefits. You have a seven-month enrollment window that begins three months before your birthday. If you do not enroll, you can be penalized with late fees for the rest of your life.
If you need to make changes to your Medicare-related healthcare decisions, you can do so during the Open Enrollment Period, commonly called the “OEP.” The annual OEP dates changed recently, and as of 2019 the OEP became January 1st through March 31st.
There are many parts, terms, and dates associated with Medicare, and it isn’t unusual to find it all a bit perplexing. It’s important to ensure you have the coverage you need. Sort through your options and compare plans with your personal situation so you can have peace of mind about your healthcare.
Sharon Wagner
