Navigating Medicare and Health Insurance Options for Seniors

It's a word that was always sort of hovering out there. But you never really gave it much thought. And, now that your age has a six and a five in it – in that order - all of a sudden, it’s the only thing you can think about.

Medicare: The federal health insurance program for people 65 and older.

Sounds simple and self-explanatory.  But once you begin exploring its ins and outs, you may conclude it is anything but.  However, one thing on your Medicare journey of discovery will be abundantly clear immediately:  It is not free.

Seriously, don’t feel like the lone ranger if you assumed Medicare is a lovely free gift from Uncle Sam. A lot of people are surprised to find it is most definitely not.  

So, What Exactly is Medicare?

Medicare for seniors is one of the largest social programs available in this country. It is made up of different parts, each offering a different type of health coverage. There are also supplemental plans as well as private insurance plans you can get in tandem with, or instead of Medicare.

You can sign up for Medicare on the Social Security website.:

• During your initial enrollment period – the 7-month period that begins 3 months before you turn 65 and ends 3 months after your birthday month.
• During the General Enrollment Period, which is annually between January 1 and March 31.
• During Open Enrollment October 15 – December 7.

What Are You Signing Up For?

This is the really fun part. The Medicare program consists of Medicare Part A, Medicare Part B, Medicare Advantage Part C, and Medicare Part D. Medigap insurance is available to supplement parts A and B. Your mission, that you have no choice but to accept, is to create a personal plan that includes the right parts for you.

Medicare Part A

Medicare Part A is known as hospital insurance. It will cover inpatient care if you are in a hospital, skilled nursing facility, or nursing home. It will also pay for hospice care and some home health care. For most people, Part A is the free part.

Medicare Part B

Medicare Part B is medical insurance similar to the health insurance you are familiar with. It comes with a monthly premium payment. So, not free. It covers medical services and supplies, and preventive healthcare like wellness visits and vaccines. For preventive care you won’t pay anything out of pocket. For other services you’ll have a deductible like you do, or did, with traditional insurance.

Part C or Medicare Advantage

Part C, otherwise known as Medicare Advantage is all the different parts of Medicare rolled into one. Medicare Advantage is similar to traditional health plans. Generally, you will need to stay within a set network of medical professionals in order to be covered. It includes preventive and outpatient medical care, hospital care and prescription drugs. It also often covers services that Medicare does not cover, like dental vision and hearing services. You would not need to purchase supplementary coverage. If you opt for Medicare Advantage, you will pay both a Medicare Advantage and a Part B premium.

Medicare Part D

Part D is the prescription drug portion of your Medicare story. Again, not free. It is regulated by the government but provided by private companies. Each company – and there are a wide variety to choose from - has a formulary, or list of the drugs it covers. For your prescription coverage you will pay a premium, deductible, and co-pay which will vary depending on the drug.

FYI Medicare Part D has a coverage gap, known as a donut hole. Once you’re in it, your plan will cover less of your expenses and you will pay 25% of your prescription drug costs.

Medigap

Even the best Medicare plan for seniors will have some gaps in its coverage. Hence, the need for Medigap, or Medical Supplemental Insurance. These policies, offered by private companies, are designed to supplement your basic Medicare coverage. Some companies will cover additional services like emergency medical care in a foreign country. What they will not cover is:

• Long-term care.
• Hearing aids.
• Glasses.
• Dental care.
• Vision care. 
• Private nursing services.

So, it’s a good thing elderly people never need any of those things, right?. Just a little snarky Medicare humor.

The idea is to sort through all the pieces of the Medicare jigsaw puzzle and put together a health plan that is compatible with both your medical needs and your wallet. Easier said than done? Again, don’t feel like the lone ranger if you decide to call an experienced professional to help you navigate the Medicare maze.