Thanks to Medicare, more than 56 million Americans – five out of six who are age 65 or older – have vital health care coverage. However, seniors and pre-retirees need to understand the finer details of the federally funded program if they want to get the full benefits to which they are entitled.
Here are several ways you or a loved one can get the most out of Medicare:
- Shopping around for the best plan every year. Parts A (hospital insurance) and B (outpatient services) of original Medicare are straightforward in their coverage. If you have earned 40-lifetime work credits, there is no premium attached to Part A, while there is a monthly premium for Part B.
It is Part D (prescription drug plan) of Medicare where enrollees can truly benefit. Medicare contracts with private insurance companies that offer seniors different coverage options, especially when it comes to prescribed medications. These coverage options, as well as the pricing of plans, often change from year to year. By simply enrolling in your prior plan without considering another plan, you could result in less coverage for your prescription drugs, not to mention higher out-of-pocket payments.
- Considering enrollment in a Medicare Advantage (MA) plan. MA plans available through private insurance companies offer the convenience of services associated with Parts A, B, and D in a single plan, rather than having to sign up for each part with original Medicare. Unlike original Medicare, MA plans also tend to cover dental, vision, and hearing visits. Better yet, there are annual out-of-pocket limits for seniors – not counting prescription drug plans – with an MA plan.
The only downside to an MA plan is that it has a smaller network of available doctors and hospitals than original Medicare, which is widely accepted by physicians and healthcare facilities. This means that your doctor may or may not be within your network with an MA plan. Also, an MA plan could require higher copays that result in higher out-of-pocket expenses, as opposed to original Medicare.
- Giving serious thought to purchasing supplemental insurance. If you have a chronic illness or serious health condition that requires frequent visits to your doctor, and you wish to enroll in original Medicare, you should look into purchasing supplemental health insurance, also referred to as a Medigap plan. That’s because Medicare only covers 75% to 80% of the final costs of medical care. A Medigap plan, which is offered by private insurers, is designed to help cover much of the medical expenses you would have to pay that are associated with Part A and Part B. Since there are many Medigap plans to choose from, you should search for one that best suits both your medical and financial needs. While Medigap premiums may add to your total monthly costs, the extra coverage can provide you with peace of mind and may reduce your annual out-of-pocket spending.
- Making sure you enroll on time. If you miss the Medicare enrollment period, it could result in substantial costs over the long term. Not only can you switch from an MA plan to original Medicare from October 15 to December 7, you can also enroll in Part D with original Medicare. The penalty for missing that deadline is 1% of the national base beneficiary premium multiplied by the number of full uncovered months in which you did not have coverage. Not only that, the penalty will continue for as long as you have a Medicare plan, and the national base beneficiary premium only increases with the rate of inflation every single year.
There are similar penalties for failing to enroll in Parts A and B when you turn 65 years old. Unless you enroll during a seven-month period – between three months before your 65th birth month to the three months following it – you may incur a 10% monthly premium penalty on Part B.
Comprehensive Medicare Health Services for Seniors in Central and South Florida
Palm Medical Centers is a Medicare health services provider with 20 convenient locations throughout South and Central Florida. In addition to providing a wide range of interdisciplinary healthcare services, we are an affiliated ACCESS site that assists recipients in social and government programs. Among other services, the ACCESS and Social Worker teams guide patients on Medicare and Medicaid application and renewals.
For more information or to make a doctor’s appointment, please contact the medical center closest to you during regular business hours.